Case 8

 A 35 year old woman with uncontrolled diabetes mellitus and bilateral lower limb cellulitis.

Hi, I am R. Ramya Keerthana, 5th semester medical student. This is an online elog book to discuss our patients health data after taking their consent. This also reflects my patient centered online learning portfolio.

Case Scenario

A 35 year old woman came to OPD on 26th May with chief complaints of:
- swelling and multiple wounds on both lower limbs below the knee associated with pain since 1 week.


History of Presenting Illness

  • patient was apparently asymptomatic 1 week ago when she developed swelling on both lower limbs below the knee which was associated with pain 
  • Swelling is sudden in onset and gradually progressive
  • Pain is sudden in onset, continuous, burning type and radiating to foot. Pain is aggravated on walking and relieved on rest and medication
  • no history of fever, nausea, vomiting, diarrhea, constipation, shortness of breath, itching of skin, headache, blurring of vision

Past History

  • k/c/o hypertension since 3 years on regular medication (telmisartan, clindipine, chlorthalidone)
  • k/c/o diabetes mellitus since 1 year associated with occasional burning micturition on regular medication (insulin-3 doses/day)
  • h/o similar complaints of swelling on left leg below the knee associated with pain and fever 1.5 years ago. She was treated with magnesium sulphate and glycerin for 3 months
  • n/k/c/o tuberculosis, CAD, epilepsy, asthma, thyroid disorder
  • no h/o of blood transfusions
  • h/o 2 previous LSCS

Personal History

  • married
  • works in a fertilizer company
  • mixed diet
  • normal appetite
  • adequate sleep
  • regular bowels
  • normal micturition
  • no known allergies
  • no addictions

Family History

- h/o hypertension and diabetes mellitus
- no heart disease
- no stroke
- no cancer
- no tuberculosis 
- no asthma
- no other hereditary diseases

General Examination

- patient was conscious, coherent and cooperative
- well oriented to time and space
- well built and adequately nourished
- no pallor
- no icterus
- no cyanosis 
- no clubbing of fingers
- no lymphadenopathy 
- bilateral pedal edema present
- no malnutrition 
- no dehydration 

Vitals

- BP: 110/90 mm Hg
- Pulse rate: 105 bpm, regular rhythm, normal volume
- Respiratory rate: 18 cpm
- Temperature: 97.4°F
- SPO2: 100% at RA
- GRBS: 345 mg/dl

Systemic Examination

Cardiovascular System
- no thrills
- cardiac sounds S1 and S2 heard
- no cardiac murmurs

Respiratory System
- no dyspnea
- no wheeze
- trachea position: central
- breath sounds: vesicular
- no adventitious sounds

Abdomen
- shape: obese
- no tenderness
- no palpable mass
- liver: not palpable 
- spleen : not palpable

Investigations













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