50M rt lower limb cellulitis with Heart failure and Renal failure

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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' 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.

Author : Dr. Sai Charan pgy2
               Dr. Pavani pgy 1 link by Dr. pavani

A 49 year old male came to OPD with chief complaints of :
RT lower limb swelling since 10days and fever since 5 days

Patient was apparently normal 10 years back then he had progressive swelling of right lower limb and diagnosed with filariasis and also diagnosed with HTN and DM since then using antihypertensive and OHA drugs.
3year back patient had observed pedal edema and went for further evaluation and diagnosed to have ?chronic renal failure
(S.cr-2).
2years back patient had COVID + following which he had SOB at rest to which he had evaluated one week after and diagnosed with Inferior wall MI.
Thrombolysed with STK and coronary angiogram was not not done in v/o high (serum creatinine) renal failure.
One month later CAG - recanalised but later he had episodes of grade four SOB and diagnosed with severe heart failure (T.hydralazine 12.5mg QID)

O/E 
Pallor +
Pedal edema +
Temp - afebrile
Pulse rate - 110bpm/min
Res count - 20 cpm/min
Spo2 - 85%
GRBS - 146mg/dl



Micturition - abnormal (decreased)
Appetite - normal
Bowel - regular

CVS : S1, S2 Heard.
RS : BAE +
P/A : Soft and Non tender
CNS : NAD.



PROVISIONAL DIAGNOSIS 
Right lower limb cellulitis 
Heart failure 2 to CAD ( old IWMI)
Chronic kidney disease 

Before bandage 


After bandage


aspiration done and serious fluid sent for culture senstivity.


Treatment : 
1)TAB.LASIX 40mg PO BD
2)TAB.HYDRALAZINE 12.5mg PO QID
3)TAB.NICARDIA-XL 30mg PO OD
4)TAB.BISOPROLOL 5mg PO OD
5)TAB.ECOSPRIN-AV 75/20 mg PO TIS
6)INJ.HAI S/C TID (acc to GRBS)
7)TAB.NODOSIS 500mg PO TID
8)STRICT I/O CHARTING
9)FLUID AND SALT RESTRICTION.



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