5 days PTA, onset of leg pain with noted of skin discoloration accompanied by occ cough and poor oral

intake. no fever noted

1 day PTA, onset of undocumented febrile episodes

Few hours , worsening condition prompted consult, hence admission

patient condition started almost 2 -3 weeks pta as body weakness with LEFT leg pains, no consult was
done until 5-7 days patient had reddish to violet discoloration of left leg with loss apetite, change in
sensorium and febrile episodes which prompted consultation our institution

+ history of chronic cough but became progressive these past few weeks

+ history of chronic tobacco smoking ( stopped past 3 years)

+ history of hpne but poor compliance with medications ( amlodipine)

at ER: patient is drowsy, weak looking, dehydrated , tachycardic, , bp- 100/70. rr- 23/min.

+ gangrenous left leg from toes to knee area, (-) pulses on affected foor not appreciated

cbc- wbc- 19, neutro- .91

bun- 24, crea= 123 ( EGFR= 18)

wt- 42 kg

assessment Sepsis sec to celluliits, t/c DVT, HCVD, cardimegaly

malnutrition, dehydration due to poor oral intake

PHx:

(+) HPN- amlodipine 10mg OD

(-) DM

(+) gangrenous left leg

VS:BP:100/70 RR: 23CR 10402saT: 96 temp: 36.2