A75 yr old man presented with Painful lesions and swelling over left leg

A 75yr old patient , resident of Narketpally,  farmer by profession , presented to the casualty with complaints of painful lesions and swelling over left leg. 


Date of Admission: 31/05/23


CHIEF COMPLAINTS 

Painful lesions and swelling over left leg since 4 days . 


HISTORY OF PRESENTING ILLNESS

Patient was apparently asymptomatic 4 days back . Then he applied zandu balm over left limb and developed swelling which was gradually progressive. 

He had h/o fever since 4 days , not associated with chills and rigor 

He had a h/o similar complaints 1 yr back followed by trauma . 


HISTORY OF PAST ILLNESS 

Not a K/c/o diabetes, hypertension, asthma , epilepsy tuberculosis , CAD

No surgical history

No history of Blood transfusions


PERSONAL HISTORY


Occupation: Farmer. 

Patient is married .

Patient takes mixed diet and has a normal appetite.

Sleep : Regular 

Bowel and bladder movements are normal.

No known allergies .

 Addictions - Alcohol : 90ml at night .

                 Bedi  : 3 times daily.


FAMILY HISTORY 


Not significant . 


GENERAL EXAMINATION 


Pallor :Not seen



Icterus : Not seen

Cyanosis : Not seen


Clubbing : Not seen


Lymphadenopathy : Not seen


Edema : Seen - pitting type .





VITALS


Temperature : 98.3℉


PR : 90 beats per minute


BP : 100/70 mm of Hg


RR : 20 cycles per minute


SpO2 : 96% in room air


Blood Sugar (random) : 97mg/dl


SYSTEMIC EXAMINATION


CARDIOVASCULAR SYSTEM EXAMINATION


s1 and s2 heard

Thrills absent

No cardiac murmurs


RESPIRATORY SYSTEM

Normal vesicular breath sounds heard.

Bilateral air entry present

Trachea is in midline.


ABDOMINAL EXAMINATION


INSPECTION


Shape - Scaphoid


Equal movements in all quadrants 


No visible pulsation, dilated veins and localized swellings.


PALPATION


Liver , spleen not palpable.


No tenderness 


CENTRAL NERVOUS SYSTEM EXAMINATION


Conscious and coherent 


Speech : Normal 


No signs of meningeal irritation 


Neck stiffness: no 

Kernig's sign : no 

LOWER LIMB EXAMINATION


INSPECTION 


 Skin over the lower limb is tense with blebs . 


Blackish discoloration over the posterior aspect of left thigh 


 Single erythematous patch over the lateral aspect of left thigh


  Bullae noted over the dorsum of left foot and leg . 


PALPATION


Tenderness present upto left thigh

Local rise of temperature present  

Fluctuation is present .

 Skin is tense . 

Pitting type of edema present over Rt. lower limb till knee joint.


PROVISIONAL DIAGNOSIS : AKI on CKD stage V with lt. lower limb cellulitis with sinus arrythmia and thrombocytopenia.

INVESTIGATIONS


1) BACTERIAL CULTURE AND SENSITIVITY REPORT 

Dt : 08/06/23


Dt : 06/06/23 


Dt : 03/06/23 



2) USG 

Dt : 06/06/2023 


3) ECG 

Dt : 31/05/23

Dt: 06/06/23 




4) 2D ECHO 

Dt : 01/06/23 


5) GRBS 

Dt - 31/05/23 


6) BLOOD UREA

Dt : 31/05/23


7) SERUM CREATININE

Dt : 31/05/23


8) SERUM POTASSIUM

Dt : 31/05/23



9) SERUM SODIUM

Dt : 31/05/23


 10) LFT 

Dt : 31/05/23


11) SERUM PHOSPHORUS

Dt: 31/05/23


12) SERUM CALCIUM 

Dt: 31/05/23


13) SERUM CHLORIDE 

Dt : 31/05/23


14) INTAKE AND OUTPUT CHARTS 

Dt : 02/06/23

Dt: 03/06/23

Dt : 04/06/23

Dt : 05/06/23

Dt : 06/06/23

Dt : 07/06/23


Dt : 08/06/23

15) FEVER CHART 


TREATMENT


1. Normal diet 


2. Inj. Monocef 1gm IV BD


3. Inj. Metrogyl 400mg IV TID


4. Inj. Pantop 40mg IV OD


5. Tab. Dolo 650 mg PO BD


6. Tab . Mut PO OD 


7. Tab . Limcee PO OD


8. Foot end elevation . 










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