Case 6.63 F with wet gangrene of rt toe

DOA 8/1/24

DOD 19/1/24

Diagnosis

WET GANGRENE OF RT GREAT TOE

S/P RAYS AMPUTATION OF RT GREAT TOE

K/C/O T2DM, HTN

Case History and Clinical Findings

C/O SWELLING OVER RIGHT FOOT AND GREAT TOE SINCE 10 DAYS

PT WAS APPARENTLY ASYMPTOMATIC 10DAYS BACK THEN SHE DEVELPED SWELLING

OVER THE RIGHT FOOT AND GREAT TOE WHICH WAS INSIDIOUS IN ONSET AND

GRADUALLY PROGRESSIVE ATTAINED PRESENT SIZE.

H/O TRAUMA WITH STONE A/W MILD PAIN

NO SIMILAR COMPLAINTS IN THE PAST

K/C/O HTN SINCE 5 YEARS

DM 2 SINCE 5 YEARS

N/K/C/O CVA,CAD,TB,EPILEPSY.

H/O TUBECTOMY 30YRS AGO.

GENERAL EXAMINATION :

PT IS CONCIOUS , COHERENT AND COOPERATIVE , MODERATLY BUILT AND NOURISHED .

NO PALLOR, ICTERUS , CYANOSIS, CLUBBING ,LYMPHADENOPATHY, EDEMA

TEMP - AFEBRILE

PR- 76 BPM

RR-18CPM

BP- 130/80MMHG

SYSTEMIC EXAMINATION :

CVS - S1,S2 HEARD , NO MURMURS

RS - VESICULAR BREATH SOUNDS HEARD , NO WHEEZE AND DYSPNEA, CREPTS IN RAA,

ISA

P/A- SOFT , NON-TENDER , NO ORGANOMEGALY

CNS - NFND

L/E

A DIFFUSE SWELLING OF SIZE 5X4 CM HAS BEEN NOTED OVER RIGHT GREAT TOE

IRREGULAR SHAPE , ULCER OF SIZE 1X1CM OVER PLANTAR SPECT OF GRREAT TOE -

SLOPING EDGES WELL DEFINED MARGINS.

ON PALPATION: TENDERNESS +

B/L PULSES PRESENT.

Investigation

NameValueRangeNameValueRangeHBsAg-RAPID08-01-2024 04:32:PMNegative Anti HCV

Antibodies - RAPID08-01-2024 04:32:PMNon Reactive COMPLETE BLOOD PICTURE (CBP) 08-01-

2024 04:32:PM HAEMOGLOBIN10.8 gm/dl15.0-12.0 gm/dlTOTAL COUNT11000 cells/cumm10000-

4000 cells/cummNEUTROPHILS60 %80-40 %LYMPHOCYTES30 %40-20 %EOSINOPHILS02 %6-1

%MONOCYTES08 %10-2 %BASOPHILS00 %2-0 %PLATELET COUNT3.11SMEARNormocytic

normochromicCOMPLETE URINE EXAMINATION (CUE) 08-01-2024 04:32:PM COLOURPale

yellowAPPEARANCEClearREACTIONAcidicSP.GRAVITY1.010ALBUMINNilSUGARNilBILE

SALTSNilBILE PIGMENTSNilPUS CELLS2-3EPITHELIAL CELLS2-3RED BLOOD

CELLSNilCRYSTALSNilCASTSNilAMORPHOUS DEPOSITSAbsentOTHERSNilRFT 08-01-2024

04:32:PM UREA 80 mg/dl50-17 mg/dlCREATININE4.7 mg/dl URIC ACID3.7 mg/dl6-2.6

mg/dlCALCIUM9.9 mg/dl10.2-8.6 mg/dlPHOSPHOROUS3.5 mg/dl4.5-2.5 mg/dlSODIUM140

mEq/L145-136 mEq/LPOTASSIUM4.6 mEq/L5.1-3.5 mEq/LCHLORIDE106 mEq/L98-107

mEq/LLIVER FUNCTION TEST (LFT) 08-01-2024 04:32:PM Total Bilurubin0.56 mg/dl1-0 mg/dlDirect

Bilurubin0.14 mg/dl0.2-0.0 mg/dlSGOT(AST)15 IU/L31-0 IU/LSGPT(ALT)14 IU/L34-0 IU/LALKALINE

PHOSPHATE185 IU/L141-53 IU/LTOTAL PROTEINS8.5 gm/dl8.3-6.4 gm/dlALBUMIN4.0 gm/dl4.6-

3.2 gm/dlA/G RATIO0.89POST LUNCH BLOOD SUGAR08-01-2024 10:25:PM333 mg/dl140-0

mg/dlSERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 10-01-2024 04:02:PM

SODIUM141 mEq/L145-136 mEq/LPOTASSIUM4.6 mEq/L5.1-3.5 mEq/LCHLORIDE105 mEq/L98-

107 mEq/LCALCIUM IONIZED1.23 mmol/Lmmol/LCOMPLETE BLOOD PICTURE (CBP) 12-01-2024

08:23:AM HAEMOGLOBIN9.6 gm/dl15.0-12.0 gm/dlTOTAL COUNT9800 cells/cumm10000-4000

cells/cummNEUTROPHILS63 %80-40 %LYMPHOCYTES30 %40-20 %EOSINOPHILS02 %6-1

%MONOCYTES05 %10-2 %BASOPHILS00 %2-0 %PLATELET COUNT2.16SMEARNormocytic

normochromic Anemia

FBS 100mg/dl PLBS 153mg/dl

Hba1c-6.5%

mg/dlSERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 12-01-2024 08:23:AM

SODIUM140 mEq/L145-136 mEq/LPOTASSIUM4.2 mEq/L5.1-3.5 mEq/LCHLORIDE103 mEq/L98-

107 mEq/LCALCIUM IONIZED1.1

2 mmol/Lmmol/LSERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 17-01-

2024 07:48:PM SODIUM141 mEq/L145-136 mEq/LPOTASSIUM4.4 mEq/L5.1-3.5

mEq/LCHLORIDE103 mEq/L98-107 mEq/LCALCIUM IONIZED1.27 mmol/Lmmol/L

2D ECHO-

IVC SIZE- 1.38 CMS NON COLLAPSING

MODERATE PR+ , TRIVIAL MR+ , TRIVIAL TR+

NO RWMA

NO AS OR MS , SCLEROTIC AV

GOOD LV SYSTOLIC FUNCTION , DIASTOLIC DYSSFUNCTION+

NO PAH OR PE.

USG ABDOMEN PELVIS -

GRADE 2 FATTY LIVER

MILD HEPATOMEGALY

GRADE 1 RPD CHANGES IN LEFT KIDNEY

LEFT SIMPLE RENAL CORTICAL CYST.

ARTERIAL DOPPLER OF RIGHT LOWER LIMB -

NO E/O DVT NOTED IN RIGHT LOWER LIMB

ALL THE ARTERIES SHOW NORMAL CALIBER ,COLOUR UPTAKE ,PULSATILITY AND PSV AND

Treatment Given(Enter only Generic Name)

TAB AUGMENTIN 625 MG PO / BD

TAB PAN 40MG PO/OD

TAB CHYMEROL FORTE PO/TID

TAB AMLODIPINE 5MG PO/OD

INJ HAI SC/TID

TAB NEUROBION FORTE PO/OD

Advice at Discharge

TAB PAN 40MG PO/OD X 5 DAYS

TAB CHYMEROL FORTE PO/TID X 5 DAYS

TAB AMLODIPINE 5MG PO/OD

TAB.SITAGLIPTIN 50mg PO/BD

TAB NEUROBION FORTE PO/OD X 5 DAYS

FOLLOW UP IN AUGUST 2024

FBS -110 mg/dl PLBS- 170 mg/dl

HbA1C- 6.4

FOLLOW UP IN FEBRUARY 2025

FBS-102mg/dl

PLBS- 140 mg/dl

Hba1c-6.4