GENERAL MEDICINE Right lower limb cellulitis with Heart failure and CKD

Hi all This is G.Chaitanya This is online E book to discuss our patients health data shared after taking his guardians informed consent form

I have been given this case to solve in an attempt to understand topic of" patient clinical data analysis" to develop my competency in reading and comprehensing clinical data including history clinical findings investigations and come with a diagnosis and treatment plan.
This is an ongoing case. I am in the process of updating and editing this E log as and when required.
 Case Scenario::-
A 49 yr old male came to medical OPD with chief complaints of Right lower limb swelling since 10 days and fever since 5 days 

History of present Illness
3 yrs back patient observed pedal edema and went for further evaluation and diagnosed as chronic renal failure.
Pt was apparently normal 10 yrs back then he has progressive swelling of right lower limb and diagnosed with Filariasis.
2 yrs back pt had COVID + ve following which he had SOB at rest, following a week later he went to corporate hospital in Hyderabad for evaluating Sob at rest and diagnosed as have inferior wall MI . Thrombolysed with Streptokinase . Coronary angiogram was not done in view of ( Renal failure) high serum Creatinine .One month later CAG - recanalised but later he had episodes of grade four SOB and diagnosed with severe heart failure (T.hydralazine 12.5mgQID

History of past Illness
10 yrs back diagnosed with Hypertension and DM
n/k/c/o Epilepsy, TB, Asthama

Treatment history
Using medication for Hypertension and Dm since 10 yrs
CAD : Recanalised CAD
No Blood transfusions

Personal history
Married
Appetite: normal
Mixed diet
Bowels regular
Micturition:Abnormal ( decreased)u
No addictions 
No known allergies

Family history
Pt Elder brother has diagnosed with DM, Hypertension
Outof 4 sisters 
One of his sister has diagnosed with Hypertension
another one has diagnosed with DM and Hypertension

GENERAL EXAMINATION
No signs of cyanosis,
 clubbing,
 lymphadenopathy,
Icterus, 
dehydration
Signs of pallor 
VITALS
Temperature  afebrile
BP:130/80 mm/Hg
Respiratory rate: 20/ min
SpO2 :85%/ at RA liters of O2
GRBS :146 mg
SYSTEMIC EXAMINATION
CVS
Cardiac sounds :S1 S2 present
No murmurs

Respiratory system
Dyspnea: no
Wheeze: no

Abdomen
Abdomen shape: obese
No Tenderness and palpable mass
Normal hernial orifice
Bowel sounds present

CNS
Pt is Conscious, coherent ,vo operative
No signs of meningitis

Provisional diagnosis ::
RIGHT LOWER LIMB CELLULITIS
HFPEF secondary to CAD
CHRONIC KIDNEY DISEASE
INVESTIGATIONS ::
11/07/2022
LFT
13/07/2022
RFT
LFT
CUE
ABG
CBP
15/07/22
Bacterial culture
16/07/2022
RFT
LFT
Haemogram
17/07/202
RFT
LFT
Haemogram
Serum Iron
18/07/2022
RFT
Haemogram
Treatment
Done dialysis on 15/07,17/07,19/07/2022
14/07/2022
INJ. LASIX 40 mg/IV/BD
TAB . HYDRALAZINE 12.5 mg/PO/OD
TAB. NICARDIA XL 30 mg/PO/OD
TAB. BISOPROLOL 5 mg/PO/OD
TAB. ECOSPRIN Av 75/20 mg/PO/Hs
INJ. HAI SIC TID ( acc to GRBS)
TAB. NODOSIS 500 mg/PO/TID 
INJ. CLINDAMYCIN 600 mg IV/ 
INJ. MEROPENAM 500 mg IV/ 
15/07/2022INJ. LASIX 40 mg/IV/BD
TAB . HYDRALAZINE 12.5 mg/PO/OD
TAB. NICARDIA XL 30 mg/PO/OD
TAB. BISOPROLOL 5 mg/PO/OD
TAB. ECOSPRIN Av 75/20 mg/PO/Hs
INJ. HAI SIC TID ( acc to GRBS)
TAB. NODOSIS 500 mg/PO/TID 
INJ. CLINDAMYCIN 600 mg IV/ 
INJ. MEROPENAM 500 mg IV/ 
16/07/2022
 INJ. LASIX 40 mg/IV/BD
TAB . HYDRALAZINE 12.5 mg/PO/OD
TAB. NICARDIA XL 30 mg/PO/OD
TAB. BISOPROLOL 5 mg/PO/OD
TAB. ECOSPRIN Av 75/20 mg/PO/Hs
INJ. HAI SIC TID (acc to GRBS)
TAB. NODOSIS 500 mg/PO/TID 
SRITCT I/O CHARTING
INJ. CLINDAMYCIN 600 mg IV/ BD
INJ. MEROPENAM 500 mg IV/ BD_

17/07/2022
 INJ. LASIX 40 mg/IV/BD
TAB . HYDRALAZINE 12.5 mg/PO/OD
TAB. NICARDIA XL 30 mg/PO/OD
TAB. BISOPROLOL 5 mg/PO/OD
TAB. ECOSPRIN Av 75/20 mg/PO/Hs
INJ. HAI SIC TID ( acc to GRBS)
TAB. NODOSIS 500 mg/PO/TID 
SRITCT I/O CHARTING
INJ. CLINDAMYCIN 600 mg IV/ 
FOOT END ELEVATION
INJ. MEROPENAM 500 mg IV/ BD
18/07/2022
INJ. LASIX 40 mg/IV/BD
TAB . HYDRALAZINE 12.5 mg/PO/OD
TAB. NICARDIA XL 30 mg/PO/OD
TAB. BISOPROLOL 5 mg/PO/OD
TAB. ECOSPRIN Av 75/20 mg/PO/Hs
INJ. HAI SIC TID ( acc to GRBS)
TAB. NODOSIS 500 mg/PO/TID 
SRITCT I/O CHARTING
INJ. CLINDAMYCIN 600 mg IV/ 
FOOT END ELEVATION
INJ. MEROPENAM 500 mg IV/ 

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