54 yrs old male patient with acute kidney injury secondary to left lower limb cellulitis

54 years old male patient came with chief complaints of shortness of breath and left lower limb swelling since 5 days .


H/o present illness:-
Patient was apparently asymptomatic 5 days back and then he had a injury to his left leg followed by itching of leg and developed left lower limb swelling associated with shortness of breath ( grade II- III) according to NYHA  classification.
No history of chest pain/palpitations.
No history of chronic cough/hemoptysis

In 2016 patient went to hospital  due to pedal edema where patient had? Ischemic encephalopathy followed by 4 sessions of dialysis was done and discharged not as any medications after that.

Past history:-
Patient is not a k/c/o Dm, asthma, epilepsy hypertension.

Personal history:
Diet-mixed 
Appetite-decreased
Bowel and bladder movements-regular
Daily alcohol consumer 5 years back,stopped 5 years back and recently he had 100 ml of alcohol

General examination:
Patient is conscious, coherent, cooperative .
Pallor +
No icterus,cyanosis,clubbing,
lymphadenopathy.
Left lower limb- Raw area of size 10x8 cms on anterio lateral aspect of left lower limb
Multiple blebs present all over the limbs
Pitting edema +
Right lower limb- 
Pitting edema+





Vitals:
PR-98 bpm
RR-29cpm
BP-130/90 mm Hg
SpO2-98% @ RA

Systemic examination:-
CVS-s1s2+
RS- BAE+
P/A- soft,non tender,BS+

Investigations;-





                    




Provisional diagnosis:-

CKD with left lower limb cellulitis

Treatment:-

Ivf Ns, RL urine output+30ml/hr
Tab lasix 40 mg po BD
Inj meropenum 500 mg/IV/BD
Inj PAN 40 mg/po/of
Inj zofer 4mg/IV/sos
Tab mvt po od
Tab vit c po/od
Left lower limb elevation
Daily dressings for LL cellulitis





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