54 year old male with vomitings, sob,fever

Medical case disscussion 

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        CASE DISCUSSION

 Patient came to causality with complaints of

Fever since 5 days

SOB since 5 days

Vomiting for 3 days

The patient was apparently asymptomatic 5 days back then he developed fever, high grade, not relieved with medication , associated with chills and rigors.

SOB since 5 days, grade III , no orthopnea , pnd.

Also presents with vomitings since 3 days, non bilious, non blood stained , watery, 2-3 episodes.

Ulcer over left foot,since 4 months, associated with edema of foot, 

H/o abscess drainage???

New bleb notes since 2 days.

K/C/O DM II since 14 years, on Metformin 500 mg and Glimiperide 1 mg BD

K/C/O Hypertension since 20 yeats , on Amlodipine 5 mg.

Patient is a vegetarian since childhood.

No addictions

No allergies

Sleep adequate

Regular Bowel and bladder

Decreased appetite

Family history-

Both of the parents mother and father had diabetes.

Father was on medication.

No Pallor, icterus, cyanosis, clubbing, lymphadenopathy.

Edema + left foot

Upto ankle

Vitals

Afebrile

BP - 80/60 mm Hg

PR- 104 bpm

RR- 18 cpm

Systemic examination

CVS- S1 S2 +

RS- BAE+

CNS- NFND

P/A - Soft, Non tender 

Investigations

Rbs- 311 mg/dl 

Diagnosis: 

Diabetic foot ulcer 

OSCE

1) How would you know that the ulcer is causing his fever 

Ans: Confirming that the organism in Pus culture 

Is also present in his blood culture

2) What explains the HYPOTENSION of the patient

A) Infection to foot can act like infective foci that may lead to decreased HR.

3) What is the cause for early onset diabetes I'm the patient

A) Familial history

4) What is the dietary modifications needed

A) Calorie count and portion control

With diabetic diet

Avoiding excess sugars, snacking and maintaining healthy lifestyle.

5) Hypertensive,but presents as hypotensive??

A) Infection being immunocompromised

6) Main treatment?

A) Primarily control of sugars with insulin

Foot incision and drainage, dressing

And regular monitering of sugars