A 63Y/M with loss of consciousness 6 hours ago

-



MED CASE :- 

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 patients' problems through a series of inputs from the available global online community of experts with an aim to solve those patients' clinical problems with collective current best evidence-based information.


This E blog also reflects my patient-centered online learning portfolio and your valuable input in the comment box is welcome.


I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations, and coming up with diagnosis and treatment plans. is an online e-log book to discuss our patient's de-identified health data shared after taking his / her / guardians' signed informed consent. Here we discuss our individual patients' problems through a series of inputs from the available global online community of experts with an aim to solve those patients' clinical problems with collective current best evidence-based information.


A 63Y/M with loss of consciousness 6 hours ago 


Patient came to casuality with the history of loss of consciousness at 3 pm today . 


HISTORY OF PRESENTING ILLNESS :- 


Patient was approved asymptomatic till yesterday evening 


then her attenders  noticed she was in altered sensorium with intact consciousness by  the time they returned from work and today

afternoon 3pm while eating patient lost consciousness( for 30 min) 

And was taken to the hospital and GRBS Was 56 ( hypoglycaemic) and was started on 25 % D 

And patient regained and intact sensorium since then and was brought here for further management.


C/O one episode of vomiting 

No complaints of fever ; vomitings ; loose stools ; pain abdomen 

Burning micturition; seizures 


PAST HISTORY:- 

Known case of DM Since 6 months ( on unknown medication) 

Known case of ? CKD since 20 yrs ( not on any medication)


Not a known case of HTN; CVA ; Thyroid ; TB ; asthma epilepsy .


PERSONAL HISTORY:-


Diet - mixed 

Appetite- normal

Sleep - adequate 

Micturition:- incontinence since 2 months 


Allergic history:- No history of any kind of allergies for food/drugs


Family history:- no significant family history 


GENERAL EXAMINATION:- 


PATIENT IS CONSCIOUS COHERENT AND CO OPERATIVE 



PALLOR-MILD 







 ; ICTERUS; CLUBBING; CYANOSIS; ; LYMPHADENOPATHY ; EDEMA


TEMPERATURE:- AFEBRILE

PR:74bpm

BP:140/90 mmHg 

RR:16cpm 

GRBS :- 66 mg/dl


SYSTEMIC EXAMINATION:- 



CVS:S1 S2+,NO MURMURS


RS:BAE+ ; NVBS ; No added sounds 


P/A:SOFT ; NON TENDER ; NO ORGANOMEGALY 


CNS :- 


Tone 

       Right                     Left 

U.L   N.                           N

L.L.   N.                           N


Power 

        Right   Left 

U.L    5/5.    5/5

L.L.    5/5.    5/5


Reflexes 

         Right     left 

B        +++.      +++

T.       +++.      +++

S.       +++        +++ 

K.        +++.      +++

A.              +.          + 


PLANTAR :- flexor.    Flexor 



PROVISIONAL DIAGNOSIS:- 

HYPOGLYCAEMIA secondary to OHA ? 

? CKD since 20 years 


HAEMOGLOBIN. 9.2 


TOTAL COUNT 5,600


NEUTROPHILS 78 

LYMPHOCYTES 17 

EOSINOPHILS 01 

MONOCYTES 04 

BASOPHILS 00

PCV. 28.7 

 

MCV 84.4 


MCH 27.1 


MCHC 32.1 


RDW-CV

15 

RDW-SD

46.6

RBC COUNT

3.40 

PLATELET COUNT 2.03 



RFT :- 


Urea :- 54 

Creatinine:- 2.7 

Sodium :- 137

Potassium:- 3.5

Chloride :- 111 


Total Bilirubin 0.58 

Direct Bilirubin 0.18

ALKALINE PHOSPHATE  646 

TOTAL PROTEINS :- 6.4 



ECG :- 






CXR :- 







DIAGNOSIS:- 


HYPOGLYCAEMIA secondary to OHA ? CERVICAL MYLEOPATHY ; NEUROGENIC BLADDER 

?AKI ON  CKD K/C/O DM since 6 MONTHS 


TREATMENT :- 

  1. WITHHOLD OHA 
  2. INJ 25 % DEXTROSE IV/STAT INFUSION @10 ml per hour depending on GRBS 
  3. GRBS Hourly 
  4. Monitor vitals 4 Th hourly 
SOAP 


14/09/2023-

ICU BED 2 
DOA - 13/09/2023

S :- 
No hypoglycaemic symptoms 


O:
Pt is c/c/c
Bp - 120/70 mmhg
Pr- 87 bpm

Cvs - S1 S2 heard no murmurs
Rs - Bae+ Nvbs
Pa- soft and non tender
Cns -
     Tone 
       Right                     Left 
U.L   N.                           N
L.L.   N.                           N

Power 
        Right   Left 
U.L    5/5.    5/5
L.L.    5/5.    5/5

Reflexes 
         Right     left 
B        +++.      +++
T.       +++.      +++
S.       +++        +++ 
K.        +++.      +++
A.              +.          + 

PLANTAR :- flexor.    Flexor 

A:

HYPOGLYCAEMIA secondary to OHA ? CERVICAL MYLEOPATHY ; NEUROGENIC BLADDER 
?AKI ON  CKD K/C/O DM since 6 MONTHS 


P:

1. WITHHOLD OHA 
2. ENT. 25% DEXTROSE IV / STAT infusion @10ml/hr  increase/decrease  depending upon Grbs accordingly
3. Monitor vitals 4 Th hourly 
4. GRBS - 2 hrly monitoring

CUE :- 
Albumin :- nil 
Sugars :- nil 
Pus cells :- 3-4 
Epi cells :- 2-3 

ECG ON 14/9 :- 




TROP I ON 14/9 
7.9 

2D echo :- on 14/9 

- TRIVIAL TR+/ AR + ;  No MR 
-NO  RWMA ; NO MS/AS ; SCLEROTIC AV 
- GOOD LV SYSTOLIC FUNCTION
- DIASTOLIC DYSFUNCTION +
- NO PAH/PE

X - RAY LS SPINE :- on 14/9 


USG done on 14/9 :- 

IMPRESSION :- 
Right Grade III RPD Changes 
Left Grade II RPD Changes 

And asked to review with full bladder.

15/09/2023-



ICU BED 2 

DOA - 13/09/2023


S :- 

No fresh complaints; stools passed 



O:

Pt is c/c/c

Bp - 120/70 mmhg

Pr- 87 bpm

GRBS :- 155 mg/dl



Cvs - S1 S2 heard no murmurs

Rs - Bae+ Nvbs

Pa- soft and non tender

CNS:- NFND 

       

A:


OHA induced HYPOGLYCAEMIA secondary to CKD (Stage IV) CERVICAL MYLEOPATHY ; HYPERACTIVE BLADDER (NEUROGENIC BLADDER )

  K/C/O DM since 6 MONTHS 



P:


  1. WITHHOLD OHA 
  2. ENT. 25% DEXTROSE IV  infusion @5ml/hr  increase/decrease  depending upon Grbs accordingly
  3. Tab Nodosis 500 mg PO/BD 
  4. Tab SHELCAL - CT PO/ OD 
  5. TAB OROFER XT PO/OD 
  6. Monitor vitals 4 Th hourly 
  7. GRBS - 2 hrly monitoring 




Comments

Post a Comment

Popular posts from this blog

3) Anecdotal self reflections on their internship learning with some video  evidence of procedures performed 

-
Image
  MY INTERNSHIP:-   I am posted in the medicine posting from 31st July to 30 Sept  Of this  PSYCHIATRY:- 31st JULY    to 14 AUG  MY PSYCHIATRY:-  I came across a patient, who was diagnosed with DISSOCIATIVE DISORDER. Diagnosis DISSOCIATIVE DISORDER Case History and Clinical Findings CHIEF COMPLAINTS: EPISODES OF STIFFNESS AND PAIN IN THE LIMBS, INVOLUNTARY MOVEMENTS OF THE BODY SINCE 15 DAYS THESE EPISODES WERE ASSOCIATED WITH MAKING ANIMAL SOUNDS FOR 5 DAYS BACKGROUND HISTORY: ABOUT 5 YEARS AGO, THE PATIENT STARTED HAVING POSSESSION EPISODES ON FESTIVALS. EACH EPISODE LASTED FOR ~15 MINUTES AND SUBSIDED ON IT'S OWN. PERSONAL STRESSORS + ABOUT 10 MONTHS AGO, HE HAD AN EPISODE OF INVOLUNTARY MOVEMENTS OF THE BODY AND STIFFNESS OF LIMBS AT NIGHT FOR WHICH HE WAS IMMEDIATELY TAKEN TO A HOSPITAL. AFTER RULING OUT THE MEDICAL CAUSES, THE PATIENT WAS REFERRED TO A PSYCHIATRIST AND HAS BEEN ON REGULAR TREATMENT SINCE THEN. HE WAS MAINTAINING WELL ON THE MEDICATION WITH AVERAGE OF 1 EPISOD
Read more

1801006069 - LONGCASE

-
Image
  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 patients' problems through a series of inputs from the available global online community of experts with an aim to solve those patients' clinical problems with collective current best evidence-based information. This E blog also reflects my patient-centered online learning portfolio and your valuable input in the comment box is welcome. I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations, and coming up with diagnosis and treatment plans. is an online e-log book to discuss our patient's de-identified health data shared after taking his / her / guardians' signed informed consent. Here we discuss our
Read more

1) Self reflective writing on their medical student career 

-
Image
  I AM K NIKHIL SAI OF the 2018 batch presently an INTERN. 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 patients' problems through a series of inputs from the available global online community of experts to solve those patients' clinical problems with collective current best evidence-based information. This E blog also reflects my patient-centered online learning portfolio and your valuable input in the comment box is welcome. BLOG:-  https://nikhilsaikarnatirollno69.blogspot.com/2023/09/a-85-year-old-male-patient-came-with.html This is me Nikhil posted in the medicine department on August 15 Th and was sitting in the casualty on my 2 nd day of posting i.e.,  And was terrified to see a patient coming to the casualty with shortness of breath for 2 days  morning. Complaints of bloating since yesterday  Complaints of decreased urine output s
Read more