65 yrs male with burning micturation since 1week

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A 65 yr old male patient came to opd with cheif complaints of fever,burning micturation since 1week, Pedal edema and shortness of breath on exertion since 2days

 HOPI: The patient was asymptomatic 6yrs ago and met with an accident and got  a fracture of right lower limb followed by plating was done. Apparently he was asymptomatic till 1week and then developed fever which was high grade associated with chills rigor and burning micturation. There was pedal edema which was pitting type since 2days which is insidious in onset and gradually progressing to knee

PAST HISTORY:

No similar complaints in the past .

Not a known case of DM,HTN,TB,ASTHMA, EPILEPSY.

Personal history: 

Diet - mixed

Appetite - normal

sleep - adequate

Bowel and Bladder movements - regular

Addictions - no

No known allergies

Family history :

No significant family history

General examination :

Patient is conscious ,coherent ,cooperative and was well oriented to time ,place and person 

at the time of examination

He is examined in a well lit room, with consent taken.

He is moderately built and well nourished.

Pallor - absent

Icterus - absent

Cyanosis - absent 

Clubbing - absent

lymphadenopathy - absent

Pedal edema - present 

Systemic examination:

Temp -Afebrile.

PR-90bpm

RR-25 cpm

Bp-120/70 mm hg

Cvs-s1 S2+

CNS-NAD

P/A- soft ,non tender 

R/s- BAE+

INVESTIGATIONS :

TREATMENT:

1. IVF 1 unit NS , RL @ 100ml /hr

2.Inj doxy 100mg Iv bd

3.Tab. DOLO 650 mg PO TID SOS 

4.Inj neomol 1gm iv sos

5.Temperature monitoring every 4th hourly.

6.Inj Optineuron 1amp 100ml ns

7.Monitor vitals and inform sos

8.Strict I/O charting

Provisional diagnosis: dengue with aki (under observation)