80/M with AKI on CKD

80yr old male came to casualty with the complaints of 

-pedal edema since 1 yr

- shortness of breath  since 1 yr

-decreased urine output since 15 days

-history of injury to left foot 10 days back 

Patient was apparently asymptomatic 10 years back then he developed B/L knee joint pains,for which patient used NSAID's from the local medical shop since 1 yr and then patient started developing pedal edema which was gradual and progressive a/w shortness of breath on exertion. 

Following which patient was normal for 10 days.

Then 10 days back Patient has injury to the left foot ,following which pedal edema aggravated on left side associated with blebs formation 

He referred to KIMS for further evaluation 

No history of HTN,DM,ASTHMA,TB,EPILEPSY, CAD.

For shortness of breath patient was using BETAMETHASONE 0.5 and salbutamol capsules. 

On examination 

Vitals:

Bp:100/70 mm of hg 

PR:100 bpm

RR:22 cpm

Spo2: 98% at room air 

Systemic examination: 

Cvs:s1s2 +

RS: BAE+

GIT: normal

CNS: normal 

INVESTIGATION: 

PROVISIONAL DIAGNOSIS :

AKI on CKD secondary to SEPSISS with LEFT FOOT CELLULITIS

 Treatment given : 

1. INJ. AUGMENTIN 1.2 GM IV BD for 5 days

2. INJ CLINDAMYCIN 600mg IV TID for 3 days 

3. INJ PAN 40mg IV OD

4. INJ OPTINEURON 1 amp IM OD

5. TAB NODOSIS 500mg PO OD 

6. TAB SHELCAL CT PO OD 

7. Left lower limb FASCIOTOMY done: 

8. Inj. MEROPENEM added (now on day 3)

Today : 22-03-2021

Lt lower limb cellulitis-s/p fasciotomy pod 4

Pt is conscious and oriented 

No fever spikes 

Grbs-148mg/dl

I/o- 1300/1000ml

Bp-110/70mmhg

Pr- 82bpm

Spo 2- 97%at ra 

Rs- bae +,Nvbs 

Cvs- s1s2+

Plan- arterial Doppler of lt lower limb 

Hemodialysis