A 70Y OLD FEMALE WITH GIDDINESS AND SLURRED SPEECH
CHIEF COMPLAINTS:
A 70year old female patient house wife by occupation was brought to casualty with complaints of giddiness and slurred speech since 1/2 hour at yesterday 9PM
HOPI:
Pt. was apparently asymptomatic till yesterday night, then she became unconscious and had hypoglycemic attack at home after taking insulin and hypoglycemic agents.
Her GRBS was 33mg/dl, and was treated in outside hospital with 25% dextrose, when she became conscious and brought to casualty.
H/o burning micturition since 3days
H/o pain lower abdomen, dragging type since 5days
No h/o fever, loose stools and vomitings
PAST HISTORY:
K/C/O Diabetes mellitus type 2 since 4years (on INSULIN and T. METFORMIN 500MG)
K/C/O HTN since 4years (on T. TELMA 40MG)
(4years ago she was admitted in our hospital with c/o giddiness and was diagnosed with HTN and DM)
No h/o TB, epilepsy
On EXAMINATION:
Pt. is c/c/c, moderately built and moderately nourished
No pallor, icterus, clubbing, cyanosis, lymphadenopathy and edema of feet
Vitals @ admission:
Temp: Afebrile
BP- 140/90mmhg
PR- 88bpm
RR- 18cpm
SpO2- 99% @ RA
GRBS- 161 mg/dl
SYSTEMIC EXAMINATION:
CVS - S1 S2 +
RS - BAE +, CLEAR,
NVBS.
https://youtu.be/jT8tgnm_C2A
https://youtube.com/shorts/CoHkgYTdze8?feature=share
P/A - soft, non tender, no organomegaly.
FEVER CHART:
INVESTIGATIONS:(2/05/2022)
RBS- 34mg/dl
HEMOGRAM: Hb- 9.4gm /dl
Tlc- 9020cells/cumm
Plt- 75000
BGT- O POSITIVE
CUE: ALB- trace
Pus cells: 3-4
Epithelial cells: 2-3
Serum creatinine- 2.1mg/dl
Blood urea -63mg/l
Na/k/cl- 137/3.5/101
LFT:
TB- 0.54; DB- 0.16; AST- 31 ; ALT-17; ALP- 341; TP-6.2;ALB-3.61; A/G RATIO -1.39
Urinary electrolytes:
Na/k/cl- 157/10.3/167
Spot urine protein: 14.2
Spot urine creat: 29.5
Ratio: 0.48
4/05/2022:
FBS- 230mg/dl
PLBS-304mg/dl
Blood urea- 49mg/dl
Sr. Creatinine- 2mg/dl
Sr. Electrolytes:
Na/k/cl: 135/3.9/102
5/05/2022:
Blood urea- 51mg/dl
Sr. Creatinine- 2.1mg/dl
Sr. Electrolytes:
Na/k/cl: 137/3.6/103
6/05/2022:
Blood urea- 63mg/dl
Sr. Creatinine- 2.1mg/dl
Sr. Electrolytes:
Na/k/cl: 136/3.7/103
ULTRASOUND:
B/L grade I RPD changes noted
DIAGNOSIS: HYPOGLYCEMIA SECONDARY TO OHA,
CKD STAGE 4 SECONDARY TO DIABETIC NEPHROPATHY(EGFR-25ml/min/1.73m2) with
MEDIASTINAL WIDENING (MEDIASTINAL MASS/?AORTIC ANEURYSM)
K/C/O DM-2, HTN SINCE 4years
ECG: 2/5/22
1. 1 . 5%D @30ml/hour
2. GRBS monitoring 1hourly
SOAP NOTES DAY 1
3/05/2022
S:
C/o Generalised weakness
C/o burning micturition since 3days
O:
PATIENT IS C/C/C
No pallor, icterus, clubbing, cyanosis, koilonychia, lymphadenopathy,edema
VITALS :
BP - 100/60MMHG
PR- 86BPM
RR- 17CPM
SPO2 - 97%
GRBS- 241mg/dl
TEMP - 98.1°F
CVS - S1 S2 +
RS - BAE +
P/A - SOFT, NON TENDER
A:
HYPOGLYCEMIA SECONDARY TO OHA
P:
1) IVF 5D @30ml/hour
2)GRBS MONITORING HOURLY
SOAP NOTES DAY 2
4/05/2022
S:
C/o Generalised weakness
O:
PATIENT IS C/C/C
No pallor, icterus, clubbing, cyanosis, koilonychia, lymphadenopathy,edema
VITALS :
BP - 110/70MMHG
PR- 83BPM
RR- 19CPM
SPO2 - 98% @RA
GRBS- 211mg/dl
TEMP - 98.6°F
CVS - S1 S2 +
RS - BAE +
P/A - SOFT, NON TENDER
INVESTIGATIONS:(2/05/2022)
RBS- 34mg/dl
HEMOGRAM: Hb- 9.4gm /dl
Tlc- 9020cells/cumm
Plt- 75000
BGT- O POSITIVE
CUE: ALB- trace
Pus cells: 3-4
Epithelial cells: 2-3
Serum creatinine- 2.1mg/dl
Blood urea -63mg/l
Na/k/cl- 137/3.5/101
LFT:
TB- 0.54; DB- 0.16; AST- 31 ; ALT-17; ALP- 341; TP-6.2;ALB-3.61; A/G RATIO -1.39
Urinary electrolytes:
Na/k/cl- 157/10.3/167
Spot urine protein: 14.2
Spot urine creat: 29.5
Ratio: 0.48
4/05/2022:
FBS- 230mg/dl
PLBS-
Blood urea- 49mg/dl
Sr. Creatinine- 2mg/dl
Sr. Electrolytes:
Na/k/cl: 135/3.9/102
A:
HYPOGLYCEMIA SECONDARY TO OHA, DM-2
P:
1) IVF 10%D @30ml/hour
2)GRBS MONITORING HOURLY
SOAP NOTES DAY 3
5/05/2022
S:
weakness( - )
O:
PATIENT IS C/C/C
No pallor, icterus, clubbing, cyanosis, koilonychia, lymphadenopathy,edema
VITALS :
BP - 120/70MMHG
PR- 78BPM
RR- 18CPM
SPO2 - 98% @RA
GRBS- 218mg/dl
TEMP - 98.6°F
CVS - S1 S2 +
RS - BAE +
P/A - SOFT, NON TENDER
INVESTIGATIONS:
5/05/2022:
Blood urea- 51mg/dl
Sr. Creatinine- 2.1mg/dl
Sr. Electrolytes:
Na/k/cl: 137/3.6/103
A:
HYPOGLYCEMIA SECONDARY TO OHA, DM-2
P:
1) INJ. INSULIN ACC. TO GRBS
2)GRBS MONITORING 4thHOURLY
3) SYP. CREMAFFIN 15ml HS
GRBS:(4/5/32)
8am- 211mg/dl
10am- 469mg/dl
2pm- 229mg/dl
4pm- 510mg/dl
8pm- 313mg/dl(INJ. HAI 8units given)
(5/5/22)
12am- 66mg/dl
12:30am- 273mg/dl
2am- 141mg/dl
4am- 180mg/dl
8am- 218mg/dl
SOAP NOTES DAY 4
6/05/2022
S:
C/o constipation
O:
PATIENT IS C/C/C
No pallor, icterus, clubbing, cyanosis, koilonychia, lymphadenopathy,edema
VITALS :
BP - 100/70MMHG
PR- 80BPM
RR- 18CPM
SPO2 - 98% @RA
GRBS- 216 mg/dl
TEMP - 98.8°F
CVS - S1 S2 +
RS - BAE +
P/A - SOFT, NON TENDER
INVESTIGATIONS:
5/05/22——>6/6/22
Blood urea- 51mg/dl——> 63mg/dl
Sr. Creatinine- 2.1mg/dl——->2.1 mg/dl
Sr. Electrolytes:
Na/k/cl: 137/3.6/103——> 136/3.7/103
A:
HYPOGLYCEMIA SECONDARY TO OHA,
CKD STAGE 4 SECONDARY TO DIABETIC NEPHROPATHY(EGFR-25ml/min/1.73m2) with
MEDIASTINAL WIDENING (MEDIASTINAL MASS/?AORTIC ANEURYSM)
K/C/O DM-2, HTN SINCE 4years
P:
1) INJ. INSULIN HAI 4U S/C
8am——1pm——-8pm
2)SYP. CREMAFFIN 15ml H/S
2)GRBS MONITORING 4thHOURLY
(Plan for discharge)
GRBS:(5/5/32)
4pm- 392mg/dl
8pm- 329mg/dl(INJ. HAI 10units given)
10pm- 190mg/dl
(6/5/22)
2am- 74mg/dl
3am- 350mg/dl
8am- 216mg/dl (INJ. HAI 8U given
