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54 years old male patient presented  with chief complaints of shortness of breath and left lower limb swelling since 5 days .

History of present illness:-

Patient was apparently asymptomatic 5 days back and then developed itching 

of leg and developed left lower limb swelling associated with blebs filled with fluid discharge. 

shortness of breath ( grade II- III) according to NYHA  classification.

In 2016 patient presented to OPD due to pedal edema where patient had Ischemic encephalopathy followed by 4 sessions of dialysis was done and discharged.

6 months ago to the right lower limb he had similar kind of swelling and infection which subsided on medication by a local doctor 

Past history:-

Patient is not a k/c/o Dm, asthma, epilepsy hypertension.

Personal history:

Diet-mixed 

Appetite-decreased

Bowel and bladder movements-regular

Consumption of alcohol daily 5 yrs back currently he consumes occasionally

General examination:

Patient is conscious, coherent, cooperative .

Pallor +

No icterus

 No cyanosis 

No clubbing

No lymphadenopathy.

Vitals:

PR-98 bpm

RR-29cpm

BP-130/90 mm Hg

SpO2-98% @ RA

Systemic examination:-

CVS

s1s2+

RS 

BAE+

P/A 

soft,non tender,BS+

Provisional diagnosis:-

CKD with left lower limb cellulitis

Treatment:-

Ivf Ns, RL urine output+30ml/hr

Tab lasix 40 mg po BD

Inj meropenum 500 mg/IV/BD

Inj PAN 40 mg/po/of

Inj zofer 4mg/IV/sos

Tab mvt po od

Tab vit c po/od

Left lower limb elevation

Daily dressings for LL cellulitis