60F WITH CAD CCF WITH BLISTERING CELLULITIS and HYPOGLYCEMIC ATTACKS
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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.
Chief Complaints -
60 year old female presented with complaints of ulcer over the left since 1 month.
History of Present Illness -
Patient was apparently alright 1.5 month ago when she developed blisters over left leg and foot which progressed to form a necrotic ulcer over the left leg.
She has associated loss of appetite and generalized weakness since 1 month.
It is associated with pain and intermittent fever. It is also associate with discharge.
No history of trauma.
No history of similar complaints in the past.
Past History -
K/C/O HTN since 3 years, on Telma 20mg OD.
N/K/C/O DM, Asthma, TB, Epilepsy.
Sequence of Events -
- History of knee pain since 5 years for which she used to get injections from an RMP (4-5 injections/ month for the past 3-4 years)
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- On September 18th, She developed cough with sputum and facial edema for which she had to be hospitalized. She was discharged the same day and recovered in about 1 week.
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- On November 4th, She developed blisters over t he ankle and lower leg. She was prescribed medication in a private hospital and was discharged.
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- By November 8th, she developed generalized weakness, loss of appetite. She was hospitalized again and was diagnosed with necrotizing fascitis. She underwent debridement and excision and was discharged on november 12th.
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- She continued to have a poor appetite, generalized weakness over the past month.
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- On December 15th, She had to hospitalized again on worsening of her symptoms. She underwent further debridement and excision of the remaining necrotic tissue.
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- On December 18th, she was admitted here with C/O chronic ulcer, loss of appetite and generalized weakness.
- She was transferred to the department of general medicine on the evening of 20th December over persistent hypoglycemia.
On NOVEMBER 6th -
On 20/12/2023
12 Am - 113.
2 Am - 95
3 Am - 73
4 Am - 72
4:30 Am -54
6 Am - 145
7 AM - 92
Pt shifted to ICU and
Started 25%dextrose infusion @30ml/hr
There was h/o starvation since 50 days
So encouraged oral feeds simultaneously
Monitored grbs one hourly and tapered infusion rate from 30ml/hr to 5 ml/hr in 12 hrs
6 pm -161. 8 pm -235. 9 pm- 187. 11pm - 242
21/12/23
12 Am -224. 6 AM -132.
1Am - 172. 8 AM -141
2 Am -212 . 10 AM - 141
4 am - 178.
Stopped infusion @12 pm, continued ryles feeding-ragi java ,protein powder in milk given
12 PM - 136.
2 pm -75
8pm -118
10 pm -124
22/12/23-morning-ragi malt
Afternoon-milk with protein powder
Eve-musk melon juice
12Am-40 6Am-90
2Am-70 8Am-62
4Am-100. 10Am-168
12pm-161. 2pm-75
23/12/2023-morning-milk with protein powder
Pt is not cooperative for ryles she removed it
Afternoon-raagi malt
Again started on ryles
Eve-raagi malt
2 AM - 112. 10AM -147. 8PM - 147
4 AM - 118. 2PM -117. 10 PM -136
8 AM -163. 4 PM -168.
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