Concluded Case

a70 ur old male with bl pedal edema hard red not warm kco of diabetes htn on insulin swelling up-to knee joint. crazy 1.8 urea 49 tlc 94 00 . my advice doppler lower limb for suspected dvt. what's yours opinion.

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1) Raised serum creatinine, with BUN serum creatinine ratio of more than 20:1 suggest prerenal type of renal failure. 2) Raised sugars and HbA1c of 10.3% suggest highly uncontrolled diabetes 3) Bilateral lower limb oedama with, redness and warmth, suggest cellulitis Impression - Infection (cellulitis) in known uncontrolled diabetes with raised creatinine, most likely prerenal type of renal failure secondary to infection. Plan - 1) Strict control of diabetes with insulin 2) IV antibiotic 3) Regular monitoring of blood sugar and creatinine 4) ECG and 2 D echo to look for cardiac function 5) Limb elevation 6) Urine routine and culture to look for urine infection 7) Liver function test, electrolyte, sonography of abdomen and color Doppler of lower limb.
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1) Raised serum creatinine, with BUN serum creatinine ratio of more than 20:1 suggest prerenal type of renal failure. 2) Raised sugars and HbA1c of 10.3% suggest highly uncontrolled diabetes 3) Bilateral lower limb oedama with, redness and warmth, suggest cellulitis Impression - Infection (cellulitis) in known uncontrolled diabetes with raised creatinine, most likely prerenal type of renal failure secondary to infection. Plan - 1) Strict control of diabetes with insulin 2) IV antibiotic 3) Regular monitoring of blood sugar and creatinine 4) ECG and 2 D echo to look for cardiac function 5) Limb elevation 6) Urine routine and culture to look for urine infection 7) Liver function test, electrolyte, sonography of abdomen and color Doppler of lower limb.
IT'S A CASE OF.. UNCONTROLLED DIABETES.. Hba1c..10.3.. DIABETIC NEPHROPATHY .. PRERENAL FAILURE.. CREATININE.. 1.95.. BUN.. 48.46. BILATERAL OEDEMA FEET.. RX.. GOOD GLYCIMIC CONTROLL WITH DIABETALOGISTS OPINION . ANTIDIURETICS..ANTIHYPERTENSIVE..AS PER REQUIREMENT.. LOW SALT DIET.. LIMB ELEVATION.. ANTIBIOTICS COVERAGE.. MAY NEEDS TO INVESTIGATE WITH.. KFT ..LFT .. USG STUDY ABDOMEN.. COLOUR DOPLER STUDY.. 2D ECHO.. ECG.. URINE C AND S EXAM.. EXPERTS OPINION IS ALWAYS BETTER.. . .
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AS. PER. REPORTS..... POSSIBLY.... CHRONIC. RENAL. FAILURE WITH. HYPERTENSION AND. D. M ADVISABLE.... 1. BLOOD. AND. URINE. CULTURE /. SENSITIVITY 2. USG..... CHEST AND WHOLE. ABDOMEN 3. ECG. X RAY... CHEST 4. LFT. ELECTROLYTES. PROTEINS 5. R /.O. ... CARDIAC. INVOLVEMENT...... AND SEPTICEMIA
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A case of diabetic and hypertensive nephropathy- to be treated on the lines of CKD .. Right now aim is to achieve strict glycemic control with increase in insulin dose as per the Plasma glucose levels.. Hypertension needs to be controlled, if on telmisartan it is to be stopped and switch over to Azilsartan or cilnidepine. Add tab ketoanalogue twice a day. Get a colour doppler study of lower limb vessels to assess vascular insufficiency if any or DVT , but apparently it looks like cellulitis. Amoxyclav 1 GM B.D is safe in CKD. It can be given. Get USG abdomen done to assess renal anatomical status , condition of liver , Ascitis if any . Also evaluate cardiac status by Echocardiography
Diabetic nephropathy. Do egfr, usg whole abdomen to check for kidney size,corticosteroids medullary differentiation.. stop metformin if taking. Better to put on insulin. Diet control. Color doppler for leg vessels can be ordered. Role of antibiotics not suggesting as TLC is normal.
Cellulitis with uncontrolled diabetes with pre renal failure.strict glycemic control , cellulites management with broad spectrum antibiotics,proper hydration,request for urune culture,color Doppler lower limb,2 d echo and other basic investigations.
Case of prerenal failure as creatinine raised with BUN raised. HbA1c of 10.3 suggest uncontrolled DM. Management of prerenal failure by IV fluids, antibiotics, limb elevation. Do Doppler to rule out varicose veins I. e. DVT
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Controll DM with insulins 2D echo Ish colour Doppler BL limbs Good antibiotic coverage Diuretics BP? F.Lipids? Spot urine microalbumin Any symptoms of peripheral neuropathy Cellulitis is not likely at this point.
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Stasis dermatitis is also present go through Doppler study to rule out varicose vein or DVT and continue the monitoring s.urea & s.cr
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