75 year old female with altered sensorium second to cellulitis
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ECG ON 13/1/23
75 year old women came to causality on 10/01/23 with
C/o SOB since one week
cough since 1 month
Fever since one week
K/C/O cellulitis - surgery done one month back
HOPI:
Patient was apparently asymptomatic 3 years ago and then developed minor abrasion to right lower limb and then developed right lower limb swelling till knee and was diagnosed to be having right lower limb cellulitis and fasciotomy was done and resolved after 2 months and at the time dm was diagnosed and kept on medication.she was normal from then and 20 days back she developed sudden swelling of left lower limb till knee intially and then progressed to thigh.she went to local hospital and found to have left lower limb cellulitis and on further evaluation found to be having erosion of knee and was diagnosed septic arthritis and incision and drainage was done and left knee osteotomy was done , fasciotomy and debridement of left lower limb was done.20 pRBC'S transfusions was done and daily dressing was done.since 5 days she developed fever which was incidious in onset,high grade,with chills and rigor.she developed SOB since 3 days and also was on altered sensorium since 3 days.
No urine output since yesterday night for which Foleys catheter was placed today morning and she is passing urine now
.
PAST HISTORY:
K/C/O DMT2 on Tab zorylmv1(metformin 500 mg +glimeperide 1mg+ voglibose 0.2mg) since 3 years.
Not a K/C/O HTN/asthma/TB/Epilepsy/CAD/CVA/Thyroid disorders.
MENSTRUAL HISTORY:
Age of menarche: 13 years
Age of menopause: 50 years
PERSONAL HISTORY:
Appetite: normal.
Diet: mixed
Bowel and bladder: regular
Sleep: adequate
Addictions: no addictions
GENERAL EXAMINATION:
Patient is drowsy but arousable.
Pallor: present
Icterus:abesnt
Cyanosis:absent
Clubbing: absent
Lympadenopathy:absent
Edema:absent
VITALS:
Temp: 97.7F
Bp:120/70mmhg
PR:90bpm
RR:16cpm
Spo2:97
GRBS:211mg/dl
SYSTEMIC EXAMINATION:
Respiratory- B/L air entry present; diffuse wheeze present
CVS- s1s2+ no murmur
P/A soft non tender
CNS- patient is drowsy
Higher mental functions
- Conscious +
- Oriented to time - ,place+ and person+
- Memory - intact
- Speech - normal
Cranial nerve examination
• 1 - olfactory sense - normal
• 2- visual acuity present,
R L
Direct reflex +. +
Indirect reflex + +
• 3,4,6 - no ptosis Or nystagmus
• 5- corneal reflex present
• 7- no deviation of mouth, no loss of nasolabial folds, forehead wrinkling present
• 8- Normal hearing
• 9,10- position of uvula is central ,Gag reflex- present
• 11- sternocleidomastoid contraction present
• 12- no deviation of tongue
Motor system
Reflexes
Right Left
Biceps 3+ 3+
Triceps 3+ 3+
Supinator 3+ -
Knee. 3+. 3+
INVESTIGATIONS:
ECG ON 10/1/23
ECG ON 12/1/23
ECG ON 13/1/23
Diagnosis:
Altered sensorium decrease evaluation meningoencephalitis secondary to left lower limb cellulitis with Septic arthritis in left knee.
k/c/o DMT2
TREATMENT
1. Iv fluids NS and RL @ 75ml/hr
2.inj.Mnocef 2gm iv/bd
3. Inj. Pan 40mg IV/OD
4. Inj. Noemal 1gm/IV/SOS
5.Inj. Zofer 4mg/IV/OD
6.inj.optineuron 1amp in 10ml NS/IV/OD
7.syrup.Ascoryl- /RT/BD
8.RT feeds - 50ml milk 4th hourly
100ml water 2nd hourly
9.NEB with Budecort and Duolin 6th hourly
10.left lower limb elevation
11.Grbs monitoring 70 profile
12.Tab zoryl mv1 (metformin 500mg+glimeperide1mg)
