swelling on right leg

C/o swelling of right lower limb since 5 days.


HOPI

Patient was appalently asymptomatic 5-6 days back, then he developed a small swelling over right lower limb near ankle  joint which he scratched and later swelling gradually increased.Associated with pain.On checking GRBS at presentation blood sugar levels found to be 542 mg/dl.
No H/o fever,Nausea ,vomiting,Burning micturation.

Past history:

Known case of DM type 2 since 9 years on GLIMI M2
N/K/C/O HTN,CVA,CAD,TB,Epilept,Thyroid disorder.

Personal history:

Patient is tailor by occupation since his age 18.He wakes up at 6 :00 AM ,he freshesup for work,starts his work by 8 AM.He has his Breakfast by 9 AM,and starts work again .He has his Lunch at 1 PM and continue his Work untill 6 PM Dinner at 8 PM .He goes to sleep at 10 PM.
Diet - mixed 
Appetite - Normal 
Sleep-adequate 
Bowel -Hard stools 
Bladder - No burning micturation.

Family History:No significant 

Fever chart :




General examination:
Patient is conscious coherent and co operative well oriented to time place and person moderately built and nourished

Vitals:

Temp-99 F

PR- 86bpm

RR-24/min

BP-160/60 mmhg
Grbs:542 mg/dl

Systemic Examination:

CVS : S1 , S2 heard, no murmurs 

RS :BAE + ,NVBS heard 

P/A :soft , non tender ,no organomegaly ,no distension ,bowel sounds heard

CNS: no focal neurological deficits




Diagnosis:
RIGHT LOWER LIMB CELLULITIS WITH UNCONTROLLED BLOOD SUGARS  WITH AKI

Investigations:

FBS:275 mg/dl
PLBS: 310 mg/dl

Hemogram:
Haemoglobin:15.4 g/dl
Red blood cells:4.99million/mm3
Pcv:32.5 %
Platelet count:2.54 lakhs/mm3
Total leucocyte count:26,500 /mm3

LFT:
TB-2.06 mg/dI
DB-0.40 mgldl
SGOT: 13 IU|L
SGPT :12 IU/L
ALP #280 IUIL
T. P: 6.0 gmldl
Alb 3.0gm/dI
AlG: 1.08

RFT:
Blood urea 58 mg/dl
Sr creatinine 1.4mg/dl
serum Na 136 mmol/dl
Serum K 3.9mmol/dl
Serum Cl 98 mmol/dl

Serology:
HBV,HIV,HCV : negative 

26/08/23:

Hba1c: 7.5 %

Hemogram:

Haemoglobin:15.6 g/dl
Red blood cells:5.05 million/mm3
Platelet count:1.6 lakhs/mm3
Total leucocyte count:26,000 /mm3.

27/08/23:

Haemoglobin:16.4 g/dl
Red blood cells:5.29million/mm3
Platelet count:2.19 lakhs/mm3
Total leucocyte count:19,800/mm3.

RFT:

Blood urea 35 mg/dl
Sr creatinine 1.1mg/dl
serum Na 137 mmol/dl
Serum K 4.2 mmol/dl
Serum Cl 102 mmol/dl

28/08/23:

Haemoglobin:18 g/dl
Red blood cells:5.56 million/mm3
Platelet count:2.20 lakhs/mm3
Total leucocyte count:15,600 /mm3

RFT:

Blood urea 28 mg/dl
Sr creatinine 0.8 mg/dl
serum Na 140 mmol/dl
Serum K 4.8 mmol/dl
Serum Cl 98 mmol/dl

29/08/23:

Blood urea 30 mg/dl
Sr creatinine 1.1 mg/dl
serum Na 136 mmol/dl
Serum K 3.7 mmol/dl
Serum Cl 99mmol/dl

30/08/23

Haemoglobin:15.7 g/dl
Red blood cells:5.13 million/mm3
Platelet count:2.03lakhs/mm3
Total leucocyte count:16,100 /mm3

RFT:

Blood urea 24 mg/dl
Sr creatinine 1.2 mg/dl
serum Na 131 mmol/dl
Serum K 3.3 mmol/dl
Serum Cl 98 mmol/dl


Right lower limb :

On 25/08/23




 
 On 26/08/23



On 30/08/23



Treatment:

1)IV FLUIDS NS @75ml/hr
2)Inj. PIPTAZ 2.25 gm IV /TID
3)Inj.
CLINDAMYCIN 600 mg IV/TID
4)Inj.HAI 
S/C TID before meals
Acc to GRBS +
Inj. NPH S/C BD
5)Tab PAN 40 mg IV/BD
6)TAB SHELCAL PO/OD
7)Syp Lactulose  15 ml PO/OD
8)INJ METACLOPRAMIDE 5 mg PO/OD
9)GRBS 7 point Profile
10)BP, PR, RR monitoring


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