A 45 year old male with complaints of left side loin pain radiating to groin since 8 days

This is the case i have seen 
 A 45 year old male farmer by occupation chronic alcoholic and smoker presented with c/o left side loin pain radiating to groin :since 8 days Fever for 1 day associated with chills : 1 week back Vomitings and loose stools for 2 days - 5 days back Decreased urine output :5 days Pedal edema :4 days Patient was apparently assymptomatic 8 days back and then he developed left loin pain radiating to groin which subsided with medication .Then he developed fever associated with chills. Vomitings :3-4 episodes and loose stools : 5-6 episodes for 2 days associated with pain abdomen subsided on medication .Decreased urine output :5days and pedal edema (non pitting , painful extending upto knees) for 4 days .No h/o chest pain/sob/palpitations. No other complaints. Not a k/c/o DM /HTN/asthma /epilepsy /CAD/TB General examination: Pedal edema + upto knees Multiple ecchymotic patches + over both lower limbs Subconjunctival hemorrhage present Dry gangrene of tip of right 3rd & 4th toes Vitals: Temperature: 98.2 F PR:82bpm Repiratory rate :18cpm Blood pressure :130/80mmhg Spo2 :98%@room air Systemic examination CVS: S1 S2 -heard ,no murmurs Respiratory system : Bilateral air entry present Normal vesicular breath sounds heard No added sounds Per abdomen: Soft , diffuse tenderness + Bowel sounds heard CNS: GCS:E4V5M6 No abnormality detected




























Diagnosis:AKI SECONDARY TO ? SEPSIS(?LEPTOSPIROSIS) 6.5mm LEFT PROXIMAL URETERIC CALUCULI  WITH MILD LEFT HYDROURETERONEPHROSIS .CHRONIC PANCREATITIS SECONDARY TO CHRONIC ALCOHOLISM AND SMOKER . HEPATITIS WITH HYPOALBUNEMIA AND THROMBOCYTOPENIA WITH DRY GANGRENE OF LEFT 3rd AND 4th TOES 


Rx: 
Inj.Cefotaxime 1gm IV/ BD
Tab.Doxycycline 100mg BD
Inj.Lasix 40mg IV/BD
Inj.Pantop 40mg IV/OD
Inj.Thiamine 1amp in 100 ml NS IV/OD
Inj.Optineuron 1amp in NS IV/OD
IV fluids NS/RL @ 100 ml/hr
Tab.Dolo 650mg QID


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