202312635

 

 


Case History and Clinical Findings

A 45 YEARS OLD MALE CAME WITH

-C/O ANURIA SINCE 1 DAY

-RIGHT LOWERLIMB SWELLING SINCE 3 DAYS

-EPISODES OF FEVER WITH CHILLS (INTERMITTENT) SINCE 2DAYS

 

HISTORY OF PRESENTING ILLNESS-

PATIENT WAS APPARENTLY ASYMPTOMATIC 3 DAYS BACK THEN HE DEVELOPED SWELLING OVER RIGHT LOWER LIMB WITH BLISTERS OVER IT ,INSIDIOUS IN ONSET, GRADUALLY PROGRESSIVE AND PRESENTLY UPTO RIGHT MID THIGH REGION. ASSOCIATED WITH DULL ACHING PAIN.

PATIENT WENT TO A LOCAL HOSPITAL AND FASCIOTOMY WAS DONE UNDER LA - SATURDAY (I.E 18/3/23)

H/O FEVER , HIGH GRADE, INTERMITTENT SINCE 3 DAYS ASSOCIATED WITH CHILLS . RELIEVED ON MEDICATION.

NO SOB

H/O ANURIA SINCE 1 DAY.

 

 

PAST HISTORY

K/C/O TYPE 2 DM SINCE 5 YEARS AND ON MEDICATIONS

•TAB GLIMEPIRIDE 1MG

•TAB METFORMIN 500MG

K/C/O HTN SINCE PAST 3 YEARS AND ON MEDICATIONS

•TAB OLMESARTAN 20MG

•TAB CILNIDIPINE 40MG

N/K/C/0 CAD, EPILEPSY, ASTHMA, TB , CVA ,THYROID DISORDERS PERSONAL HISTORY -

APPETITE NORMAL DIET-MIXED BOWEL-REGULAR

BLADDER- ANURIA SINCE 1DAY

H/O ALCOHOL INTAKE SINCE 18 YEARS

 

 

GENERAL EXAMINATION

PATIENT IS CONCIOUS COHERENT AND COOPERATIVE

NO PALLOR ,ICTERUS, CYANOSIS, CLUBBING , LYMPHADENOPATHY EDEMA PRESENT -PITTING TYPE

VITALS-

BP -160/90 MM HG PR-94BPM

 

TEMP-96.4 F RR- 24CPM

SPO2- 95%ON RA GRBS - 97MG/DL

 

SYSTEMIC EXAMINATION-

CVS-S1, S2 HEARD , NO MURMURS

RS-BAE , DECREASED BREATH SOUNDS ON RIGHT IAA, ISA P/A- SOFT , NONTENDER

 

PATIENT CAME WITH THE C/O RIGHT LOWER LIMB SWELLING SINCE 3DAYS ,FEVER SINCE 2DAYS (INTERMITTENT WITH CHILLS) AND ANURIA SINCE 1DAY

AND INVESTIGATIONS FOUND TO HAVE HB - 9.0 TLC -16,000 WITH S.UREA-114 S.CREAT - 5.6 AND NA +-119

K -3.0 CL -92 SO PATIENT WAS TAKEN TO DIALYSIS AND SURGERY CONSULATATION WAS TAKEN AND MANAGED CONSERVATIVELY WITH IV FLUIDS AND ANTIBIOTICS,INSPITE TLC COUNTS STARTED INCREASING AND PATIENT LANDED UP WITH ARDS AND FLASH PULMONARY ODEMA .MANAGED WITH INTERMITTENT CPAP AND NEBULIZATION (RESOLVED) MEANWHILE DAILY HAEMODIALYSIS IS BEING DONE ALONG WITH PRBC TRANSFUSIONS WITH DAILY WOUND CARE AND THIS PROGRESSED TO NECROTISZING FASCIITIS LANDED IN SEPTIC SHOCK

BLOOD AND URINE C/S -NO GROWTH AND TISSUE C/S SHOWED ACINETOBACTER (SENSITIVE COLISTIN) AND THEN HIGHER ANTIBIOTICS WERE GIVEN AFTER WHICH TLC COUNTS STARTED TO DECREASE AND AT PRESENT.AND A TOTAL OF 10 SESSIONS OF HAEMODIALYSIS AND 4 UNITS OF BLOOD TRANSFUSION DONE

TODAY AT TIME OF DISCHARGE - INVESTIGATIONS . PATIENT VITALS -

TEMP 100F

BP 140 /80 MMHG PR 111BPM

RR 24 CPM

SPO2 99 % GRBS 148MG/DL NA+ 140

K+ 3.5

 

CL- 101

CA2+- 1.06

S. UREA- 45 CREAT- 3.6 ABG-

PH- 7.27

PCO2- 19.4

P02- 89.6

HCO3- 8.8

HB- 7.5

TLC- 18000

NEU- 81

LYMP- 09

PCV- 25.4

RBC- 2.70

PLT- 2.57

Investigation

2D ECHO- EF- 58% NO RWMA

MILD LVH PRESENT MILD MR/AR PRESENT

MODERATE TR PRESENT WITH PAH ECCENTRIC TR+,

SCLEROTIC AV NO AS/ MS

DIASTOLIC DYSFUNCTION PRESENT NO PE

BLOOD AND URINE CULTURE AND SENSITIVITY SHOWED NO GROWTH AND SWAB C/S LO ACINETOBACTER SENSITIVE TO COLISTIN

IVC SIZE 1.38 CMS

Treatment Given(Enter only Generic Name)

-IVFS -NS AT 75ML/HR

-INJ PIPTAZ 4.5 GM /IV /STAT

 

-INJ.MEROPENAM 500MG IV/BD FOR 8 DAYS

-INJ PAN 40 MG /IV /OD

-INJ HAI S/C TID

-INJ COLISTIN 1.5 MILLION UNITS FOR 9 DAYS

-INJ TIGECYCLINE 50 MG FOR 9 DAYS

-TAB NICARDIA 10MG PO/TID

-TAB DOLO 650MG PO/SOS

-SYP ASCORIL LS 10ML PO/TID

-INJ HAI S/C TID ACCORDING TO GRBS

Advice at Discharge

HEAD END ELEVATION UPTO 45 DEGREE INJ PAN 40MG IV/OD

INJ LASIX 40MG IV/TID

INJ TRAMADOL 100MG IN 100ML NS IV/BD TAB NICARDIA 10MG PO/TID

TAB DOLO 650MG PO/SOS SYP ASCORIL LS 10ML PO/TID

INJ HAI S/C TID ACCORDING TO GRBS


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