ALTERED SENSORIUM (RESOLVED)SECONDARY TO SEPSIS- SEPTIC ENCEPHALOPATHY WET GANGRENE OF LEFT 3RD TOE- S/P DISARTICULATION OF 3 RD TOE ON 10-08-2023 WITH CELLULITIS OF LEFT LEG WITH UNCINTROLLED SUGARS WITH THYOE II DM AND HTN WITH ANAEMIA (NCNC)

Case History and Clinical Findings
 C/O ALTERED SENSORIUM SINCE 3 DAYS C/O ULCER OVER LEFT FOOT SINCE 3 MONTHS C/O BURNING MICTURITION SINCE 15 DAYS
 HOPI :
PATIENT WAS APPARENTLY ASYMPTOMATIC 1 MONTH AGO AND HE HAD ULCER OVER THE LEFT FOOT-3RD TOE NO H/O TRAUMA,INJURY BURNING MICTURITION SINCE 15 DAYS,ALTERED SENSORIUM SINCE 3 DAYS H/O IRRELAVANT TALK,NOT ABLE TO RECOGNISE ATTENDERS9ALTERED SENSORIUM MORE DURING EVENING) N/H/O FEVER,VOMITING,LOOSE STOOLS,PAIN ABDOMEN,GIDDINESS
 PAST HISTORY:
K/C/O TYPE 2 DMSINCE 25YRS ON INJ HUMAN MIXTARD 10-100 SINCE 20 YRS K/C/O HTN SINCE 20 YRS ON TAB TELMA-H PO/OD
PERSONAL HISTORY : 
SLEEP-ADEQUATE DIET-MIXED APETITE-NORMAL ADDICTIONS-OCCASIONAL ALCOHOL CONSUMPTION ,H/O SMOKING ,STOPPED 1 YR BACK ALLERGIES-NONE O/E PATIENT IS CONSCIOUS, IRRITABLE, ORIENTED TO TIME, PLKACE, PERSON NO SIGNS OF PALLOR,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY,PEDAL EDEMA 
VITALS : TEMP-96.8 F BP-120/70 MMHG PR-78 BPM GRBS-171 MG/DL SPO2-97 ON RA CVS :S1,S2 HEARD,NO MURMURS RS:BAE +,NVBS 
CNS: GCS RIGHT LEFT POWER UL 5/5 5/5 LL 5/5 5/5 TONE UL N N LL N N REFLEXES B 2+ 2+ T 1+ 1+ S - K 1+ 1+ A - PLANT FDLEX FLEX P/A :SOFT,NON TENDER ,BOWEL SOUNDS+
Investigation 
HB -8.8 MG/DL TLC-18000 /CUMM PCV:25.8 VOL% PLT COUNT-3.88 LAKH/CUMM RBC-3.27MILLION/CUMM APTT:31SEC INR:1.11 UREA-23 MG/DL S.CREAT-1.7 MG/DL NA-132 MEQ/L K-3.8 MEQ/L CA:9.7MG/DL CL-99 MEQ/L TB/DB-0.59/0.20 SGOT/SGPT-14/16 ALP-286IU/L TP-5.8GM/DL A/G-0.99GM/DL RBS:60MG/DL FBS:222MG/DL HBA1C:7.4 
2D ECHO :
 NO RWMA, MILD AR +, / MIULD TR +/ ASOCIATED WITH PAH , EF-67%, GOOD LV SYSTOLIC FUNCTION DIASTOLIC DYSFUNCTION + IVC - 1.10 CMS, COLLAPSING COLOR DOPPLER OF LEFT LL : ALL EXAMINED ARTERIES SHOW NORMAL TRIPHASIC WAVE FRONT EXCEPT ATA, PTA, PERONEAL , DPA ARTERIES WHICH SHOW BIPHASIC WAVEFORM AND HIGH VELOCITIES ATHEROSCLEROTIC CHANGES IN ALL EXAMINED ARTERIES SCUBCUTANOOUS EDEMA IN LEFT LOWER LIMBLEFT INGUINAL LYMPHADENOPATHY NO EVIDENCE OF DVT 
TREATMENT -:
IV FLUIDS AT 75ML/HR INJ PIPTAZ 3.375GM IV QID FOR 3 DAYS INJ CLINDAMYCIN 600MG IV BD FOR 3 DAYS TAB TELMA-H PO/OD INJ. OPTINEURON 1 AMP IV /OD Advice at Discharge REFER TO HIGHER CENTRE PATIENT AND PATIENT ATTENDER HAVE BEEN EXPLAINED ABOUT THE CONDITION OF THE PATIENT THAT IS ALTERED SENSORIUM SECONDARY TO SEPTIC ENCEPHALOPATHY WITH LEFT 3RD TOE GANGRENE WITH CELLULITIS OF LEFT LEG WITH TYPE2DM HTN.THE SURGERY TEAM HAS ADVICED FOR VASCULAR SURGEON OPINION , THE CASE IS REFERED TO HIGHER CENTRE FOR VASCULAR SURGEON INTERVENTION AND MANAGEMENT. THEN HOSPITAL MANAGEMENT, STAF, DOCTORS ARE NOT RESPONSIBLE FOR ANY UNTOWARD EFECT WHILE TRANSPORTING THE PATIENT AND OUTSIDE THE HOSPITAL . 
Follow Up
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