A 75 year old male with CKD

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Date of admission: 10/01/23
Chief complaints: A 75 year old male was brought to the casualty with chief complaints of decreased urine output since 1 week and shortness of breath since 1 week
History of present illness: Patient was apparently asymptomatic 3 months back and then he developed lower limb cellulitis of left leg and debridement was done with dressings.
Patient had uncontrolled sugars with 500mg/dL blood sugar level, and was diagnosed with UTI
Patient developed fever with chills and loose stools.
Burning sensation of right lower limb 
Burning micturition and was treated with antibiotics.
Patient developed decreased urine output and shortness of breath and 4 sessions of hemodialysis was done 
PRBC transfusion was done.
History of past illness: patient is a k/c/o DM since 12 years and is on medication
k/c/o of HTN
Known case of Chronic kidney disease since 5 years 

Clinical examination: 
GENERAL EXAMINATION

• Pallor - absent
• Icterus - Absent 
• Clubbing - Absent 
• Koilonychia - Absent 
• Lymphedenopathy - Absent 
• Pedal oedema - absent 
• JVP - Normal 

VITALS
• Temperature - 99°F 
• Pulse rate - 98bpm
• Respiratory rate - 20 cpm
• BP - 160/80 mmHg
• SPO2 - 97% on room air 




Systemic Examination:

CARDIOVASCULAR SYSTEM:

No Thrills, 
S1,S2 sounds hears,
No murmurs. 

RESPIRATORY SYSTEM:
INSPECTION:
Chest is symmetrical
Trachea:central
PALPATION:
Trachea:central
AUSCULTATION:
Vesicular breath sounds
No wheeze 

ABDOMEN:
INSPECTION:
shape-scaphoid
Flanks-full
Umbilicus-everted and central position 
Hernial orifices-nornal
No dilated veins 
No scars and sinuses 
PALPATION:
Non tender
No Local rise of temperature 
No palpable Mass 
Spleen and liver not palpable 
AUSCULTATION:
Bowel sounds-present
CNS:
Patient is drowsy
Speech is incoherent
No signs of meningeal irritation
Cranial nerves are intact
Glass gow coma scale: E-4, V-2, M-6
Investigation
Diagnosis: Acute kidney injury on Chronic kidney Disease with cellulitis of left lower limb
Treatment:
Inj lasix 100mg iv stat
Tab nicardia 20mg
Tab nodosis 500mg
Rules tube feeding every 4th hour



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75 year old female with altered sensorium second to cellulitis

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This is an online e-log book to discuss our patient's de-identified health data shared after taking his/her/guardian's informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based input. A 75 year old women came to causality on 10/01/23 with  CHIEF COMPLAINT: C/ofever since one week SOB since one week  cough since 1 month  K/C/O cellulitis - surgery done 1 month back HISTORY OF PRESENT ILLNESS: Patient was apparently asymptomatic 3 years ago and then developed minor abrasion to right lower limb and then developed right lower limb swelling till knee and was diagnosed to be having right lower limb cellulitis and fasciotomy was done and resolved .she was normal from then and 1 month back she developed sudden swelling of left lower limb till knee intially and then progressed to thigh.she went to
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