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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