45year old woman with SOB and generalized odema

A 45 year old woman, laborer by occupation, resident of Nalgonda came to medicine OPD with chief complaints of
Difficulty in breathing since 2 hours
Generalized edema since 3 months
History of Present Illness-
The patient was apparently asymptomatic 3 months ago, then she suddenly noticed edema of the feet. She continued to go to work and observed that her swelling has progressed to upper limbs and abdomen and face,
Edema was sudden in onset and rapidly progressive associated with pain, started with edema
The pain was dragging type, insidious in onset and was throughout the day. Aggravated on movement and supine position. Relieved on medication and sitting.
Pain eventually spread to the entire body.
2 months ago she went to a hospital in Nalgonda, where she was told she had some kidney related issue. She took medicine for 1 month irregularly. 
The edema didn't subside, so she decided to come to KIMS where she was told she has to undergo dialysis.
The patient was apparently anxious and about it and left to Nalgonda govt. Hospital.
While in the waiting, she started having difficulty in breathing and immediated came back to KIMS.
No h/o fever, local rise of temp, cough, cold, burning micturition, oliguria, headache vomiting, loose stools and constipation and NSAID abuse
Past history-
No similar complains in the past.
2 LSCS done. 24years and 18 years ago
Tubectomy 18 years ago
4 years ago, she was diagnosed with DM when she went to local hospital because she fainted during her work. Treatment- tab. Glimepride 2mg
3 years ago, she was diagnosed with HTN when she went to local hospital because of fever. Treatment- tab. Atenolo 50 mg
2 years ago, thorn price on the left little finger. The thorn was removed and the digit was casted which left the finger flexed at distal interphalangeal joint
Family history- 
Mother has DM, HTN and bilateral renal disease.
Personal history-
Married 
Diet mixed but vegetarian after told by doctor at Nalgonda
Appetite normal
Sleep adequate
Bowel and bladder movements are regular
No Addictions
No allergies
General Examination 
Physical Examination 
The patient was conscious, coherent and cooperative 
Well oriented with time, place and person
Moderately built and nourished
Pallor present, pale finger nails
No icterus
No cyanosis
No Clubbing of fingers
No lymphadenopathy 
Bilateral Pedal edema, pitting type, from below the knee and upper limb
Vitals 
Pulse- 108bpm
BP- 150/110 mm Hg
Respiratory rate- 26 times/min
Temp- Afebrile

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