Disclaimer:-
This is a HIPAA de-identified open-online-patient-record with initial information in patient's voice, posted here december 2016 after collecting informed patient consent (form downloadable here) by BMJ Elective Student.
6yrs back she had giddiness for which she went to hospital & was diagnosed as diabetic.. Though she was advised with insulin therapy, she did not take it regularly(took insulin only when she had giddiness)
1yr back she had an episode of vomiting which relieved after taking symptomatic treatment from local physician...
On 4 months back she presented with c/o non healing ulcer & burning micturition with nausea, vomiting..
vitals were stable & Grbs was 314mg/dl.. signs of pallor & dehydration were present.. On examination 15×10cms spreading ulcer with foul smelling necrotic slough present over lateral aspect of Rt ankle & foot... On investigating Hb level-7.2gms ; TLC-6100 ; FBS-152 ; PLBS-171.
Pt was diagnosed as a case of diabetic foot ulcer with UTI.. pt was managed with surgical debridement, daily dressings, IV antibiotics, IV fluids & other supportive measures... Pt responded well with resolution of nausea, vomiting, improvement in oral intake & wound health... she started taking insulin daily from then..
After 25days she visited the hospital again for Split skin graft... Vitals were stable at that time.. on examination 15×8 cms ulcer over lateral aspect of Rt ankle & foot with healthy granulation & sloping edges is seen.. Hb level is 8.7, TLC 7600.. urine for ketone bodies is positive.. potassium was 2.8...
She was then taken for Split skin graft next day. there was an episode of vomiting 2days after surgery which relieved after symptomatic treatment..
Dressing was opened on POD-5 & healthy site with 90% graft uptake is noticed.. being fit for discharge, she was sent home when the vitals were stable at that time...
15days later when went for regular followup, she was told that the Graft was rejected & was on regular dressings every alternate day..
Second toe of Rt foot got amputated 20days back (it being dry gangrene)
20 days after SSG surgery, she had episodes of vomitings which lasted for 5days.. she was presented in the general medicine OPD 5 days back, with the c/o vomitings and loose motions since 5days...
Vomitings:- watery, nonbilious, non projectile, containing food particles, no blood in vomitus..
Loose stools:- watery in consistency, non blood stained, non mucous, small in quantity..
She attained menarche at the age of 13yrs, she had regular cycles for every 28days with 3days flow.. no clots & no pain... She isn't menstruating since 5months & her LMP was 5 days back.. there is a h/o white discharge since 1yr..
Age at marriage -16yrs, Went to Infertility clinic 1yr after marriage as she was not conceiving... & Was told that she was very weak, advised to take MVT..
No significant family history..
On examination pt is c/c/c.. no signs of pallor, cyanosis, clubbing, lymphadenopathy, edema..
Vitals:- bp 170/110 & Grbs was 83..
RS :- NVBS +
CNS:- MSE - normal
P/A :- soft, non tender.
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