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Step 1: View clinicals

A 55-year-old man presents with worsening swelling of his left leg for three days. He is running a high fever and appears mildly confused. His wife also mentions that he has lost his appetite since the onset of symptoms. This is his fifth such episode in two years. None of the previous events were this severe, with all of them rapidly responding to antibiotic therapy. His medical history is significant for poorly controlled type 2 diabetes mellitus for 10 years, which is complicated by grade 3 diabetic retinopathy and stage 2 diabetic nephropathy.

Step 2: Order all relevant investigations

Complete blood count

WBC: 25,000/mm3 (4,600-11,000) Neutrophils: 95% Lymphocytes: 4% Hb: 14.1 g/dL (12-18) Hematocrit: 43% (35-45) Platelets: 210,000/mm3 (150,000/450,000)

Random plasma glucose

His random plasma glucose is 465 mg/dL

Renal functions + Electrolytes

Blood urea nitrogen (BUN): 59 mg/dL (6-20) Serum creatinine: 1.7 mg/dL (0.5-1.5) Na+: 135 mEq/L (135-145) K+: 4.1 mEq/L (3.5 - 5.5) Cl-: 104 mEq/L (95 - 105)


On room air: pO2: 95 mmHg (> 75) pCO2: 35 mmHg (35-45) saO2: 97% pH: 7.35 (7.35-7.45) HCO3-: 25 mmol/l (24-32)

Step 3: Select appropriate management

ICU care
DVT prophylaxis
IV fluids stat
Cardiac inotropes stat

Score: ★★☆