40 year old with chief complaints of GIDDINESS SINCE 3 DAYS LOOSE STOOLS SINCE 3 DAYS YELLOWISH DISCOLOURATION OF SKIN SINCE 2DAYS HISTORY OF PRESENTING ILLNESS : Patients was apparently asymptomatic back then he developed blebs on skin of the palm and thigh which was itchy and slowly progressed through out all the body over 2 months No treatment was taken for the same Lesions are non oozing, initially med which then turned dark and left as pigmented seat on the skin. later 3 days back patient developed loose stools and vomiting after using herbal medications for the lesions Patient skipped 3 days taking insulin LOOSE STOOLS - water consistency , 20episodes/day , sticky , foul smelling not A/W food intake VOMITINGS - whitish food , non projectile , not blood tinged YELLOWISH DISCOLOURATION - eyes and skin since morning with itching Patient developed ulceration @ Rt foot and had amputation of toe PAST HISTORY K/c/o Diabetes since 8 years was started initially on OHA’s and
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