Complicated case of DM

70y,M DM for 3yrs. Irregular in treatment, diagnosed as Hypertensive by some one 2months back & treated with TELMISARTAN 80 + HCTZ 12.5. Had developed ulcer 15days back. Came to me with disoriented condition, Nausea, vomiting. Discontnued antiHTN drug 2 days & now BP is 134/82mmHg. Investigation report shows FBS - 96, 2hrPPBS-146, Urea 40, Creatinine 1.6, Na - 115, K - 2.6, Total Cholesterol - 164, TG - 129, HDL - 34, LDL - 106, TLC 9,600, Hb - 9.6 Suggest treatment.

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I hope he is controlled with oha.At present he is having electrolyte imbalance. Kindly treat it . please start inj.insulin with antibiotics. He needs anti aneamia line of management with monitoring of BP. Electrolytes and control of diabetes

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A Diabetic foot with hypertension with diabetic nephropathy with hyponatremia . Considering a raised s creatinine levels , antibiotics o be used with caution. Correct hyponatremia with n.saline . Diabetic control with insulin . Continue renoprotective antihypertensives like cilnidepine, azilsartan . A colour doppler to assess the vascular insufficiency. If present tab cilostazol can be given . Tab alfa - ketoanalogue twice a day for diabetic nephropathy. Local wound dressings with mupirocin and oral amoxyclav

Sir, pt has discontinued antihypertensive drug & now BP is not high. Can we give Tolvaptan along with 3%NS for Hyponatremia?
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DYSELECTROLYTEMIA HYPONATRAEMIA hyp9kalaemia due to CTD LOW HDLc ARF ( FLUID LOSS --DIURETIC ,VOMITING ) IV FLUID NORMAL SALINE + potassium chloride. 1/2 amp in each bottle 500ml 4 hrly Rpt, BLOOD N.a. + k+ 1 hr ly ONDENSTERONE i v IV antibiotics Dressing of wound STATIN at later date . Doppler ultrasound of arteries at later date Blood + urine osmolaritu if possible 24 HRS URINE & URINARY Na+ 3% Nacl 1oo cc 9 dr0ps / mt if in COMA 2

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Control Blood Sugar Level Magsulph dressing Tab Ziffi Turbo 600 mg bd Tab Seredic P bd Cap Multivitamin

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As far as foot is concerned It's a typical diabetic foot It requires debridement followed by dressings wih septiloc and foot care along with with antibiotics ac to culture sensitivity Itll require resurfacing by SSG later

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Impetigo

Correct his electrolyts imbalance .

Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

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Yes disoriented status is due to hyponatremia. Correct electrolyte imbalance fist. Then usual but be cautious treatment for diabetic foot and probably Nephropathy.

Please consider Doppler for both legs.
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Correct his electrolytes imbalance First give 3%saline@8-10 ml hr Give Kcl @ 5 ml per hr through infusion pumps Then think of other conditions

On the same plan we are going. Thanks.
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