71 year old male with c/o decreased urinary output and rt lower limb cellulitis




This is an online E-log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed 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 inputs. 


This E log book also reflects my patient centered online learning portfolio and your valuable comments on comment box is welcome.


I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.


Case based OSCE along with Bloom's learning levels acheived


Patient came with c/o decreased urinary out put since 4 months  with right lower limb cellulitis since 1 month 

Patient was apparently asymptomatic 4 months ago then he had decreased urinary output, patient had thorn prick on 27/8 /23 and he got admitted in local hospital treated by rmp he has done incision and drainage and then patient developed swelling in rt lower limb with boils over rt ankle and then admitted to our Casuality with high s. Creat value and reffered to nephrology for hemodialysis 


Case was reffered to surgery department and debridement was done under spinal Anesthesia on 10/9/23

6 sessions of hemodialysis was done 


Past history 

K/C/O DM since 10 years

Not a k/ c /o HTN,thyroid,TB,Epilepsy 


Family history  Not significant 


Allergic history:-

No history of any kind of allergies to food/drugs


GENERAL EXAMINATION:- 

THE PATIENT IS CONSCIOUS COHERENT AND COOPERATIVE 

NO PALLOR ; ICTERUS; CLUBBING; CYANOSIS; ODEMA ; LYMPHADENOPATHY


TEMPERATURE:- 98.8 F 

PR:81bpm

BP:90/60mmHg

RR:30cpm





SYSTEMATIC EXAMINATIONS:-


CVS:S1 S2+,NO MURMURS

CNS: NAD

RS:BAE+ ; NVBS 

P/A:SOFT ; NON TENDER ; NO ORGANOMEGALY 





PROVISIONAL DIAGNOSIS:- CKD with k/C/O DM 2 since 10 years,  S/P below knee amputation with 6 sessions of hemodialysis 

Investigations 

11/9 serum creatinine- 4.5 

Blood urea -78 

Hb - 8.7, TLC - 17,200 


12/9 serum creatinine- 5 

S. Urea 84 

14/9 s.creat values 7.8 

S. Urea - 191 

16/09/23 

S.creat 8.6 

S.urea 211 

18/9/23 

S.creat  - 4.3 

S. Urea- 64 

Ecg 


 




Treatment 

I/v fluids NS 30 ml 

Inj. Meropenam 500 mg I/v BD 

Inj Clindamycin 600 mg I/v Bd 

Inj lasix 200 mg IV/ BD 

Inj neomol 1 gm IV if temp > 101F 

Inj Human Actrapid insulin according to Grbs 

Inj. Nor adrenaline 

Inj Dobutamine

Tab dolo 650 mg PO/ BD




Questions in yesterday’s discussion:- 


Level 2 :- 

How to differentiate between different types of shock ?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6323133/ 

 


Question 2 :- 

AKI AND CKD ?


https://www.researchgate.net/figure/Differences-between-AKI-and-CKD_tbl3_41895379  


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531835/


 



Learning points- 


Below knee amputation 


 https://www.ncbi.nlm.nih.gov/books/NBK534773/ 




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