A patient with swelling on left leg

A patient aged 77 year old came to opd with 
Cheif complaints:
 swelling on left leg since 15 days, low grade fever since 15 days
History of present illness :
 patient was apparently asymptomatic 15 days ago, then he developed swelling in his left leg
          -which is insidious in onset,
          - gradually progressive
          -no relieving or aggravating factors
Low grade fever since 15 days
         - not associated with chills and rigors
         -no cough and cold
         - relieved on medication
No shortness of breath
No palpitations, chest pain
History of trauma is present
Past history:
          Known case of hypertension since 8 years
Not a known case of diabetes mellitus , epilepsy, thyroid
Had cellulitis,necrotizing infection 6 years ago on left leg
Had a accident with car 9 years ago,had a tibia implant 9 years ago, it was removed 5 years ago
Personal history:
           -mixed diet
           -regular bowel and bladder movements
           - adequate sleep
           - occasional alcohol consumption
           - beedi smoking
Family history: not insignificant
General examination:
 Patient is conscious,coherent,cooperative.
          No pallor, icterus, cyanosis, clubbing,lymphadenopathy.
          Oedema of feet is present
        Vitals: 
          Temperature: afebrile
         Bp:150/90 mm Hg
         Respiratory rate:22 
         Pulse:83 beats per minute
 Systemic examination:
   Cardiac: s1,s2 heard
   Respiratory:bilateral equal entry of air
   Per abdomen: non tender,soft
   CNS: NFD
Local examination: 
foot to knee swelling of left leg
Local rise of temperature
Tenderness present
Pitting edema present
Pulse not palpable
Inguinal lymph nodes not palpable

Investigations:
27-08-



28/8/23


29/8/23


30/8/23








provisional diagnosis: 
Acute kidney injury with cellulitis

Treatment:

Iv fluids ns @ 75ml per hour
Inj meropenem 1 gm b.I.d/iv
Inj retrocyl  500mg Iv/tid
Tab chymorel forte tid
T.vit c of
Mg so4 dressing
Left leg elevation
Vitals monitoring

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