A case of 48 yr old male with UNCONTROLLED SUGARs n FEVER UNDER EVALUATION

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 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. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box
A 48 yr old male  welder by occupation came with complaints of  FEVER since 4 days
C/O chest pain since 5 days 
Pt was apparently asympyomatic 4 days back then developed fever ,intermittent,associated with chills and rigors ,no burning micturition
Chest pain on n off ,non radiating
Pt was k/C/o DM since 4 yrs on inj Mixtard
Pt was havi g complaints of weight loss, fever 4 yrs ago and diagnosed with pulmonary kochs and used ATT for 6 months
After using ATT for 2 months pt had 1 episode of seizure  then came to our  hospital and diagnosed with high sugars and then insulin started
Pt takes insulin irregularly 
Pt had complaints of tingling sensation of B/L LL since 1 yr whenever he has those symptoms he used think due to night dose of insulin and he use to skip night insulin dose 
No complaints of vomitings,loose stools,cough and SOB
Non smoker 
Non alcoholic
General examination 
Pt is C/C/C
No pallor cyanosis clubbing icterus lympadenopathy
Mild edema present
Temp 98.6
PR 86 bpm
Bp 110/70 mmHg
RR 18 cpm
Spo2 98 %@RA
GRBS 700 mg/dl
Systemic examination
Cvs s1s2+
RS BAE+
P/A SOFT NONTENDER
CNS NAD
Investigations
Hb 10.5
TLC 10,200
PLT 1.50 
ESR 90

RBS 702 
CUE
ALB ++
SUGAR ++++
PUS CELLS 24 TO 26

CRP 2.4 
LFT
TB 1.01
DB 0.26
AST 15 ALT 19
ALP 168
TP 6.3
ALB 3.2
RFT
B UREA 48
S CREAT 2.0
SODIUM 129
K 4.1
Cl 99
24 hrs urine creat 0.53g/day
Protein 329 mg/day
Ecg
Chest x ray
Usg

Fever chart

Clinical images
Usg

Provisional diagnosis
FEVER UNDER EVALUATION 
 WITH UNCONTROLLED SUAGRS? DIABETIC NEPHROPATHY
Treatment
1 .IVF NS RL @ 50ML /HR
2. TAB NITROFURANTOIN 100 mg po BD
3.TAB .DOLO 650mg po BD
4.GRBS monitoring





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