60 year old male with Uncontrolled blood sugars with right lower limb cellulitis
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C/o swelling of right lower limb since 8 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.
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
On 31/08/23:
Dressing done with papaya to form granulation tissue
GRBS Monitoring:
On admission night
25/08/23
9pm -563 mg/dl
10PM- 445 mg/dl
11 PM -409 mg/dl
12 AM- 360 mg/dl
1 AM -287 mg/dl
2AM- 262 mg/dl
3 AM- 256 mg/dl
4 AM -241 mg/dl
5 AM -245 mg/dl
6 AM-251 mg/dl
7 AM- 244 mg/dl
8 AM- 240. mg /dl
On 26/08/23
8AM:240 mg/dl
10AM:288 mg/dl
2PM:245 mg/dl
4PM: 320 mg/dl
8PM:346 mg/dl
10PM:318 mg/dl
2AM:155 mg/dl
On 27/08/23
8AM:181 mg/dl
10AM:285 mg/dl
2PM:243 mg/dl
4PM: 235mg/dl
8PM:213 mg/dl
10PM:248mg/dl
2AM:310mg/dl
On 28/08/23
8AM:286mg/dl
10AM:357mg/dl
2PM:313mg/dl
4PM: 303mg/dl
8PM:310mg/dl
On 29/08/23
8AM:255mg/dl
10AM:355mg/dl
2PM:311mg/dl
4PM: 208mg/dl
8PM:146mg/dl
10PM:252mg/dl
2AM:241mg/dl
On 30/08/23
8AM: 187mg/dl
2PM:224mg/dl
4PM: 186mg/dl
8PM:107mg/dl
10PM:134mg/dl
2AM:95mg/dl
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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