A 67 year old Male with Fever ,lowerlimb swelling ,sob ,rt.ear pain

Thursday, February 10, 2022

AKI 2° TO LEFT LOWER LIMB CELLULITIS ,CKD 2° TO ANALGESIC NEPHROPATHY H/O HTN WITH DENOVO - DM ANAEMIA UNDER EVALUATION RIGHT EAR PAIN UNDER EVALUATION

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A 67 YEAR old male came with c/o left lower limb swelling since 10 days , fever since 10 days ,SOB on exertion since 3 days 

HOPI:

Patient was apparently asymptomatic 5 yrs back,on our routine investigation diagnosed as hypertensive (om medication tab. amlo 5 ) and had b/l knee pains since 4 yrs back underwent knee replacement, 3 yrs back had developed Left limb swelling and serous discharge for which he underwent debridement and fasciotomy. Patient was taken to pulse hospital stay for 1 month (creat : 5.8 to 3.8). Since 1 month c/o right ear pain .

From 27 th jan patient had lower limb swelling- sudden onset , gradually progressive to current state, aggrevated on walking ,relieved on rest and limb elevation , swelling associated with pain which is insidious in onset , non progressive, intermittent aching type ,aggrevated with movements, relieved with medications.

Fever since 10 days intermittent,high grade associated with chills and rigor .

SOB - Insidious onset, gradually progressive from grade 1 to 2 since 3 days ,no orthopnea/pnd.

No h/o burning sensation of urine , decrease urine output.

Past h/o: 

Hypertension since 5 yrs not on regular medication (amlo- 5mg, aten-50 mg)

Diabetes- denovo 2 days ,not on any medication,

Surgery- B/Lknee replacement

No h/o BA,TB,CVA 

Addictions: smoking- 1 to 2 cigarettes/day since 20 years, stopped 1 month back

General examination:

pallor -++

oedema of feet + left lower limb

on local examination- oedema of left LL + involving foot ,ankle and leg 

Tiny ulcers + largest  1x1 cm over Posterior aspect of leg, multiple patches of skin loss +,mild local erythema+, tenderness+ , pitting edema + , peripheral pulses +

No cyanosis, icterus, clubbing, lymphadenopathy.

Vitals: temp:afebrile, PR :106bpm,RR: 18 cpm, spo2 : 98@ ra , BP:120/80 MMHG, GRBS : 134 mg/dl

CVS: S1S2+ ,JVP raised

RS: BAE+

CNS: NAD

PROVISIONAL DIAGNOSIS: AKI 2° TO LEFT LOWER LIMB CELLULITIS ,CKD 2° TO ANALGESIC NEPHROPATHY

 H/O HTN WITH DENOVO - DM 

 ANAEMIA UNDER EVALUATION ?  

 RIGHT EAR PAIN UNDER EVALUATION

Treatment given:

1.IVF- NS,RL at uo+30 ml/hr

2. Inj . Clindamycin 600 mg iv BD 

3. Inj. Piptaz 2.25 gm iv/TID

4. Inj pantop 40 mg iv OD

5. Inj zofer 4 mg iv sos