75 year old male with CKD with Known diabetic and sepsis

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Clinical history: 

 70/M, whose is a farmer by occupation was apparently asymptomatic 10 years back..Had expiry of his son 10years back ,stopped going to work.and after 6 months patient had increased urine output with burning sensation of both lower limbs and found to be diabetic and hypertensive and started on OHA's and used to OHA's on /off ( only when patient had increased urine output,he used to take OHA's ).

Patient used to plant vegetables in his home and used to garden as his daily routine.his pension was taken monthly by his daughter and house 🏠 was also named after her legally.

(Which is forced by his daughter)

5 years back patient developed swelling of the right lower limb with blisters ,went to the hospital and Knicks were given on the rt lower limb ( ? Fasciotomy )and discharged and also found his renal parameters were deranged.

Every year since 5 years patient had admission(once a year ) in to outside hospital in view of right lower limb swelling and got discharged.

Last year in October 22, patient had fever and swelling of the left lower limb with blisters and went to the hospital, and Knicks were given on left lower limb ( ? fasciotomy).and discharged.

From October in view of left lower limb swelling with pain ,patient used to take nsaids injection for pain relief.

On Jan 1st , patient had burning micturition, difficulty in passing stools,fever with chills and decreased urine output.

In view of difficulty passing stools patient drank castor oil and passed 7-8 episodes of stools and went to hospital in nalgonda.

There patient was kept on antibiotics,the next day patient Developed SOB , he was started on hemodialysis 4 sessions done with 3 PRBC transfusion and electively intubated and extubated the next day. Could not bear expenses in outside hospital, patient came here for further management.

Past history: 

Known case of diabetes since 10 years 

Known case of Chronic kidney disease since 5 years 

Clinical examination: 

GENERAL EXAMINATION

Patient is Drowsy,but arousable.

• Pallor - absent 

• Icterus - Absent 

• Clubbing - Absent 

• Koilonychia - Absent 

• Lymphedenopathy - Absent 

• Pedal oedema - absent 

• JVP - Normal 

VITALS

• Temperature - 99°F 

• Pulse rate - 98bpm

• Respiratory rate - 20 cpm

• BP - 160/80 mmHg

• SPO2 - 97% on room air 

.CVS-S1S2 +

RS - BAE+, B/L crepts+ with Rhonchi .

• GRBS - 172 mg/dl 

Diagnosis: Acute kidney injury on Chronic kidney Disease on Hemodialysis secondary to Diabetic Nephropathy with known case of Diabetes, cellulitis of the left lower limb with Bed sore.