Complicated case of DM

70y,M DM for 3yrs. Irregular in treatment, diagnosed as Hypertensive by some one 2months back & treated with TELMISARTAN 80 + HCTZ 12.5. Had developed ulcer 15days back. Came to me with disoriented condition, Nausea, vomiting. Discontnued antiHTN drug 2 days & now BP is 134/82mmHg. Investigation report shows FBS - 96, 2hrPPBS-146, Urea 40, Creatinine 1.6, Na - 115, K - 2.6, Total Cholesterol - 164, TG - 129, HDL - 34, LDL - 106, TLC 9,600, Hb - 9.6 Suggest treatment.

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A Diabetic foot with hypertension with diabetic nephropathy with hyponatremia . Considering a raised s creatinine levels , antibiotics o be used with caution. Correct hyponatremia with n.saline . Diabetic control with insulin . Continue renoprotective antihypertensives like cilnidepine, azilsartan . A colour doppler to assess the vascular insufficiency. If present tab cilostazol can be given . Tab alfa - ketoanalogue twice a day for diabetic nephropathy. Local wound dressings with mupirocin and oral amoxyclav

Sir, pt has discontinued antihypertensive drug & now BP is not high. Can we give Tolvaptan along with 3%NS for Hyponatremia?
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Thank you doctor
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As far as foot is concerned It's a typical diabetic foot It requires debridement followed by dressings wih septiloc and foot care along with with antibiotics ac to culture sensitivity Itll require resurfacing by SSG later

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DYSELECTROLYTEMIA HYPONATRAEMIA hyp9kalaemia due to CTD LOW HDLc ARF ( FLUID LOSS --DIURETIC ,VOMITING ) IV FLUID NORMAL SALINE + potassium chloride. 1/2 amp in each bottle 500ml 4 hrly Rpt, BLOOD N.a. + k+ 1 hr ly ONDENSTERONE i v IV antibiotics Dressing of wound STATIN at later date . Doppler ultrasound of arteries at later date Blood + urine osmolaritu if possible 24 HRS URINE & URINARY Na+ 3% Nacl 1oo cc 9 dr0ps / mt if in COMA 2

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Do regular dtessing Slough removal In the end bone might get exposed The distal soft tissue is unhealthy. Soft tissue cover may be impossible due to vascular problems. Get an arterial and venous doppler of the foot. Get a plasic surgeon to see the case. I have seen these kind of cases ending up in toe disarticulation at a later stage when bones get infected.

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I hope he is controlled with oha.At present he is having electrolyte imbalance. Kindly treat it . please start inj.insulin with antibiotics. He needs anti aneamia line of management with monitoring of BP. Electrolytes and control of diabetes

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आयुर्वेद के अनुसार यह मधुमेह जनित दुष्ट व्रण है। चिकित्सा संबंधी योग,,,, गैंदा के फूल और हल्दी को गाय के मूत्र में पीसकर लेप करें और फिर उस पर पट्टी बांध दें अगले दिन सुबह गाय के मूत्र से धो लें और फिर यही कार्य करें मृत्युंजय रस स्वर्ण युक्त 1 रत्ती सत गिलोय 4 रत्ती शहद में मिलाकर सुबह-शाम सेवन कराएं निश्चित रूप से लाभ होगा योग परिक्षित है पिछले 40 वर्ष से प्रयोग कर रहा हूं

Correct his electrolytes imbalance First give 3%saline@8-10 ml hr Give Kcl @ 5 ml per hr through infusion pumps Then think of other conditions

On the same plan we are going. Thanks.
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Yes disoriented status is due to hyponatremia. Correct electrolyte imbalance fist. Then usual but be cautious treatment for diabetic foot and probably Nephropathy.

Please consider Doppler for both legs.
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Wounds looks healing xray CT angiogram dressing with megaheal aug625 bd

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