Date of admission:4/9/22

A 50 yrs old female presented to opd with chief complaints of necrotic patch on right toe 

History of present illness:

   Patient was apparently a symptomatic one month back.she had developed necrotic patch /bleds on right toe since 15 days.patient suffering with diabetes mellitus since 10 yrs.

She was treated in Nalgonda hospital and advanced amputation but has level was 7.5 mg/dl .after which she was referred to our hospital .patient complaints of pus discharge with foul smelling.movement of right toe is reduced.

Patient complaints of dark /black pigmentation extending till the middle of foot is seen .no sensation occur over the toe .


History of past illness:

  >Not a known case of CAD,asthma,TB,epilepsy,thyroid disorder

>no history of blood transfusion in the past

>patient suffers with hypertension 


Personal history:

Diet:mixed

Loss of appetite:poor 

Sleep:regular

Bowel and bladder movement:irregular 

Micturation :abnormal 

Menstrual history:post - menopausal

Respiratory system:regular

Family history:

   No one in family complaints with similar complaints of necrotic patch

—-everyone in her family is suffering with diabetes mellitus 


Allergic history:

Patient is not allergy to any known cause of food

They is no known allergy to dust or pollen 


General examination:

  -patient is conscious,coherent,co-operative 

 - no cyanosis,clubbing 

 -no lymphadenopathy 

 -  no dehydration 

 - pallor is present 

 - malnutrition- present 


Vitals:

Temp -a febrile 

Pulse rate -98 bpm/mm

Resp rate -14 cpm /min

Bp -120/80 mm/hg

Spo2 - 98%

GRBS -170 mg/dl


Systemic examination:

Cvs -NAD

VENOUS DOPPLER:

1. CFV,FV, proximal deep FV ,ATV,vessel of right lower limb are examined 

2. Examined vessels shows normal colour flow,compressibility,respirophasic

3. No hyperexhoric foci is examined


ARTERIAl DOPPLER:

1.CFV,FV,DPA is examined

2.examined vessels shows normal colour uptake,waveform

3 examined vessels shows few regions of wall calcification 

4.no significant stenosis is noted.


Respiratory system:NVBS +

CNS - s1,s2 +

P/A-obstruction +

INVESTIGATION:

1.HEMOGRAM:


2.URINE CREATININE:



3.blood sugar:


4.liver function test:


5.HBsAg -rapid:


6.HIV rapid test:


7.serum electrolytes:



8.ECG:





TREATMENT :

1-IVF -NS ,Rl-100 ml/hr

2.inj .piptA2-2.25 gms IV /TD

3.inj .zofee-4 mg IV /TID

4.inj lasix -4mg iv /bd

5 .inj metrogly-480 mg iv 





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