A 81 year old male

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Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 

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Here is a case i have seen:

81yr old male Patient came to the casuality at 4.30 pm with chief complaints of High grade fever , with one episode of reddish brown color Urine withhyperpigmentation of skin of both lower limbs
High grade fever associated with chills and rigors ,burning micturition since 1 month on and off
Urine is reddish brown with diurnal variation ,foul smelling ,hesitancy of urine present .
Normal stream , Normal volume and frequency.
Tingling sensation of both lower limbs .
No H/O cough ,loin pain ,trauma to bladder ,froathy urine .
Patient was apparently asymptomatic 30 yrs back and developed varicositis of both lower limbs ,operated for varicositis of left lower limb (1st operation ) 15 yrs back and (2nd operation )to same left lower limb 14yrs back ,right lower limb 7 yrs back.
Operated for left renal stone 20 yrs back .
N/k/c/o HTN ,DM2 , TB,Epilepsy,CVA, CAD,TB.
H/O fever 1 month back on and off associated with burning micturition.
PERSONAL HISTORY-
Appetite :normal
Diet : mixed
Bowels: regular
Drinks alcohol occasionally,drinks kallu every day since 3 years 750ml/ day 
GENERAL EXAMINATION-
Pt is C/C/C
No pallor ,icterus,clubbing,cyanosis ,lymphadenopathy.
Pedal edema present in left lower limb up to knee.
VITALS-
Temp:98.6F
BP: 120/80mmhg
PR:92bpm
RR: 20cpm
SPO2: 99%
GRBS 96mg%
CVS- s1s2 heard,no murmurs 
RESP- BAE+
CNS -NAD
DIAGNOSIS - AKI secondary to ATN with UTI  secondary to ecoli with grade 1 BPH  with glomerular nephritis  secondary to infection (resolving)
TREATMENT- 
IVF -NS,RL
Tab.Nitrofurantoin 100 mg BD 
Tab PCM 500mg SOS.
Condom catheterisation










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