COVID-19: Dry gangrene of lower limb leading to amputation and partial loss of vision

 


The Case

A 75 year old M known case of HTN, Post PTCA now a COVID-19 patient presented to another hospital with gradual blackening of the left lower limb gradually progressing to dry gangrene. Below knee amputation was required to save life. He developed mild AKI and vision has reduced to 50% as complained by him. He is fully conscious oriented with oxygen saturation adequate. After 25 days of initial symptoms his systemic symptoms have not resolved.

  

Hb- 10.7 gm/dl

TLC-12.22/ mm

N77

Urea 68 mg/dl

Cr- 1.4 mg/dl

UA 4.1 mg/dl

Na- 129 meq/L

K 4.03 meq/L

PO4 4.49 mg/dl

Alb 2.65 gm/dl

Ferritin 222 ng/ml

IL6 18.88 pg/ml

CRP 4.17

D-dimer 2.44

LDH 272 IU/L

Vit D3 121 nmol/L

 

==

COVID-19 is now recognized to involve almost every organ of the body. The most common classification of severity is based on oxygen requirements.

Generalized symptoms such as fatigue, neuropsychiatric illness, and depression have persisted.

 

Loss of taste has been well recognized.  

 

Changes in vision and limb gangrene are less commonly seen.

 

At this moment it is difficult to separate if the present condition resulted from COVID-19 or anything else.

==

Dr. Prashant Kumar

 

https://www.covid19treatmentguidelines.nih.gov/overview/clinical-spectrum/


Comments

  1. Dr Satish Bhardwaj29 May 2021 at 20:43

    Yes systemic involvements are under reported, since we are still overwhelmed by Pulmonary involvement and are concerned with only improving the Oxygenation.

    ReplyDelete
    Replies
    1. Dr. Prashant Kumar30 May 2021 at 06:44

      Very appropriately said. I have also included the paper cutting of similar cases reported from elsewhere.

      Delete
  2. Dr. Prashant Kumar30 May 2021 at 06:45

    But I also think that this is not thrombosis alone. May be some degeneration at tissues level.

    ReplyDelete

Post a Comment

Thanks for your comments, will reply you soon!!!

Popular posts from this blog

How To Choose The Correct Size Of Suction Catheter

Image
  How To Choose The Correct Size Of Suction Catheter Dr. Prashant Kumar Background: Suctioning of the artificial airway is a common procedure in everyday clinical practice. 1. Indication: Need to suction a tracheal/ tracheostomy tube should be assessed frequently as necessary by anyone providing care to the patient. The frequency of assessment may be as frequent as continuous in patients with very high secretions to as low as once in several days in dry-clean airways. No generalization can be made on this point.      The decision to suction a tracheal tube must be made on the basis of the clinical need to maintain the patency of the tracheobronchial tree. No routine suctioning should be performed based on timing alone. A tracheal tube should only be suctioned when clinically indicated by signs which could include:   i. visible, palpable or audible secretions (such as sputum, gastric or upper airway contents or blood)   ii. respiratory: desaturation, rising peak inspirat
Read more

How often do you test Vitamin D levels and does it matter in your ICU?

Image
How often do you test Vitamin D levels and does it matter in your ICU?     Vitamin D is essentially needed in general population and the critically ill. This vitamin has significant role in maintaining immune function, cardiovascular state, glucose control and mucosal barrier function etc.     70 to 100 % have vitamin D deficiency in the ICU.   Vitamin D supplementation is safe in general population and ICU patients. Hypervitaminosis D should be avoided through correct replacement regimen.   Normal desirable levels: Labs report Vitamin D3 levels in two different units; ng/mL & nmol/L   1 ng/mL = 2.5 nmol/L   Normal value 30-100 ng/mL (75 to 250 nmol/L) Anything over 100 ng/ml (250 nmol/l) for a prolonged period may be harmful. Dietary supplement upto 4,000 IU or less per day is considered safe.   Supplements comparisons and dose schedules   Oral Orally administered Vitamin D3 partially gets metabolized by the hepatic 25- hydroxylase enzyme a
Read more

Midline catheter- basilic vein cannulation: in difficult peripheral venous access

Image
            The Case A 47 year old M was admitted with COVID-19 disease. His constitution is obese with very difficult peripheral venous access. Central venous access is fraught with air embolism in a respiratory distress patient and is considered to accompany more complications.   *Midline catheters* How it is inserted   Generally the basilic or cephalic veins are too deep to be visualized superficially. Therefore, ultrasound is used to place the cannula.   This required skill and practice. -==-     Dr. Prashant Kumar
Read more