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A 45year old male patient, resident of AP lingotam, was presented to the casualty with chief complaints of
CHIEF COMPLAINTS
- Excessive sweating for 1 day
- Altered sensorium for 1 day
the patient was apparently asymptomatic 10 years ago when he was diagnosed with DM. Since then he is on medication, OHAs. 6years ago, he developed an ulcer on his left foot, little toe, which got infected.it became gangrenous because of which they amputated the little toe. 8 months ago he developed similar leisons again in left foot and 4th toe was amputated. 3 months back, the patient was pricked by a thorn following which he developed ulcer. Following which he also developed plantar abcess, necrotising fascitis and anemia.he had undergone debridment and split skin graft.one month ago he developed generalised tonic clonic seizures and was diagnosed to have hyponatremia seizures. 1 day ago he skipped an afternoon meal following which he developed excessive sweating and altered sensorium for which he came to the hospital.
PAST HISTORY
H/o DM since 10 years, on insulin since 5yrs and OHAs since 10yrs
No h/o HTN
PERSONAL HISTORY
Alcohol consumption occasionally
No h/o smoking
Diet mixed
Appetite normal
B&B regular
FAMILY HISTORY
no significant family history
EXAMINATION
GENERAL
Patient is conscious, coherent and co operative
patient is moderately built and nourished
Pallor present
Cyanosis absent
Icterus absent
Clubbing absent
Lymphadenopathy absent
VITALS
BP 110/70mmHg
PR 70 bpm
Resp rate 18/min
GRBS on admission: 55mg%
SYSTEMIC
CVS
S1 S2 heard
No murmers
No thrills
RESPIRATORY
Position of trachea central
Vesicular breath sounds heard
No wheeze
No dyspnoea
ABDOMEN
Soft, non tender
No free fluid
No palpable mass
INVESTIGATIONS
PROVISIONAL DIAGNOSIS
Hyponatremia secondary to diabetes mellitus
TREATMENT
Inj piptaz 4.5 gm IV stat
Inj 3% NaCl / IV / 10ml /hr
Inj optineuron 1 amp in 100ml / NS /IV/ OD
Inj pan 40mg /IV /ID
Case updates
On 30/6/22, fasciotomy was done on his left leg due to compartment syndrome which he developed following necrotising fascitis.
He developed sepsis, secondary to cellulitis of left lower limb? Following which guillotine amputation, below knee was done.
His wound and tissue swab were sent to microbiology lab and e coli was isolated which is sensitive to amikacin, gentamicin and meropenem
Serum sodium chart:
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