45 year old male patient with T2DM Uncontrolled sugars (resolved) AKI secondary to sepsis (resolving) Right foot gangrene - s/p Disarticulation of second , third and fourth toes

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A  45 year old male patient came to the casualty with compliants of blackish discoloration of second and third toes of right foot.

HISTORY OF PRESENT ILLNESS

•Patient was asymptomatic three days back ,then he developed a swelling on the right foot .He applied spirit after which he developed blackish discoloration of second and third toes of right foot.

•History of burning sensation of foot since two days 

•No history of fever , nausea, vomiting , giddiness

•No history of foot pain , claudication pain

PAST HISTORY

•History of diabetes mellitus type 2 since three years and on INJ.H.MIXTARD

•Not a known case of hypertension, tuberculosis ,asthma, CAD.

PERSONAL HISTORY

Appetite - decreased

Diet- Mixed 

Sleep - adequate

Bowel and bladder movement- regular

Addictions - Alcohol and tobocco since 20 years

FAMILY HISTORY

Not significant

GENERAL EXAMINATION

Patient was conscious , coherent, cooperative .

Moderately built and moderately nourished

Pallor - present

No icterus, cyanosis, koilonychia, clubbing, lymphadenopathy, odema

Vitals -

Temperature -98.4°F

Pulse rate -100 bpm

Respiratory rate -18 cpm

Bp -180/100mmhg

SpO2-99%

Grbs - High

 LOCAL EXAMINATION  -

CVS -S1,S2 heard , No murmurs

RS -  BAE + , NVBS

       

P/A - SOFT , NT

CNS: NFND

INVESTIGATIONS- 

Hemogram

Thyroid profile

Liver function tests

Renal function tests

Urine for ketone bodies

Blood sugars

Complete urine examination

USG report

Provisional diagnosis

T2DM with Uncontrolled sugars (resolved)

AKI secondary to sepsis (resolving)

Right foot gangrene - s/p Disarticulation of second , third and fourth toes 

Treatment

1.Debridement and disarticulation of second , third and fourth toes 

2.Inj.Piptaz 2.25 gm IV/TID

3.Inj.Clindamycin 600 mg IV/TID

4.Inj.HAI 6 U TID

5.Inj.NPH 8 U --- X --- 6 U

6.Inj.Optineuron 1amp in 100 ml NS IV OD

7.Inj.Thiamine 1amp in 100 ml NS IV TID