A 37 YEAR OLD MALE:-
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CHIEF COMPLIANT:-
A 37 y male Farmer came to casualty with c/o
decreased urine output since 4 days
swelling of RT lower limb since 4 days
HISTORY OF PRESENT ILLNESSES:-
pt. was apparently asymptomatic 4 days back then he had a sanke bite while he working in the farm around 6:00 am ,he didn't see the snake and was taken to a near by local hospital around 9:00 am and given treatment with universal ASV for 3 days and refered to our hospital I/V/o dialysis.as his creatinine was 6.1
no c/o shortness of breath , cough , cold , palpitations .
h/o 1 PRBC transfusion with 2 sdp transfusion done yesterday
history of past illness- not a K/C/O DM/HTN/TB/ASTHMA.
no significant treatment and family history
o/e- pt is c/c/c moderately built and nourished
edema of right leg
temp- 98.5°f
PR- 99/MIN
RR-18/MIN
BP- 110/80 MMHG
SPO2- 98% at room air
grbs-151mg %
CVS-s1s2 heard
RS- BAE +
ABD-NAD
CNS- NAD
PROVISIONAL DIAGNOSIS- AKI 2° TO SNAKE BITE( NEUROTOXIC)
? ATN WITH RT LOWER LIMB CELLULITIS
IInvestigations
ECG
USG
22/10/21
24/10/21
Serum ldh:-1580
X-ray chest:-
USG Abdomen:-
27/10/21
S
c/o pain in rt lower limb
c/o cough
One fever spike @ 8 am
Thrombophlebitis present in lt hand
O
Vitals:
Temp- 101 °F
PR-111 BPM
RR-18 cpm
BP-130/80mmHg
SPO2- 97 @ room air
I/O: 1000/1550
Ur-118
Cr-4.3
UA-4.8
Na-132
K-3.6
Cl-94
Serum ldh-1580
28/10/21
29/10/21
Treatment :
Day 1
1 session of hemodialysis for 2 hours along with prbc transfusion
Surgery referral and dressings done for rt lower limb cellulitis
Day 2
1 session of hemodialysis done for 2 hrs
Dressings done for rt lower limb cellulitis
Tab pan 40 mg po/od
Day 3
Dressing for cellulitis
Tab pan 40 mg po/od
Day 4
Dressing for cellulitis
1 session of hemodialysis done
Tab pan 40 mg po/od
Day 5
Dressing for rt ll cellulitis
Tab pan 40 mg po/od
Tab dolo 650 mg /sos
Tab zofer po/sos
SYP ASCORYL 10 ml
Inj optineuron 1 amp in 100 ml NS /IV /OD
Day 6
Planning for dialysis with transfusion as his hb is 4.9 ( dialysis done with prbc transfusion )
Dressing for rt ll cellulitis
Inj augmentin 1.2 gm IV/BD
Tab pan 40 mg po/od
Tab dolo 650 mg /sos
Tab zofer po/sos
SYP ASCORYL 10 ml
Inj optineuron 1 amp in 100 ml NS /IV /OD
Day 7
Dressing for rt ll cellulitis
Inj augmentin 1.2 gm IV/BD
Tab pan 40 mg po/od
Tab dolo 650 mg /sos
Tab zofer po/sos
SYP ASCORYL 10 ml
Inj optineuron 1 amp in 100 ml NS /IV /O
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