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3.

 Case History and Clinical Findings

  A CASEOF 49 YEAR OLD FEMALE PATIENT WAS BROUGHT TO CASUALITY BY HER ATTENDER IN A STAGE OF UNRESPONSIVE TODAY MORNING. 

HISTORY OF PATIENT ILLNESS:

PATIENT WAS APPARENTLY NORMAL 2MONTHS BACK THEN SHE DEVELOPED FEVER LOW GRADE ON AND OFF,INTERMITTENT,SOME TIME ASSOCIATED WITH CHILLS AND RIGORS, NO DIURNAL VARIATION NOT WITH COUGH,COLD ,BURNING MICTURITION + WHICH WAS RELEVED WITH MEDICATION.THEN TODAY MORNING PATIENT TOOK ORAL HYPOGLYCEMIC TABLET 10 MINUTED BEFORE CONSUMPTION OF FOOD AND HAD BREAKFAST AND SAT ,SUDDENLY SHE BECAME UNCONSCIOUS,ON ARRIVING HOSPITAL HER GCS WAS E1V1M1. 

PAST ILLNESS: K/C/O HTN SINCE 5 YEARS :ON UNKNOWN MEDICATION K/C/O DM 2 SINCE 2 MONTHS:ON UNKNOWN MEDICATION

 PATIENT IS CONSCIOUS COHERENT, COOPERATIVE.

NO PALLOR,NO ICTERUS, NO CYANOSIS,NO CLUBBING,NO LYMPHADENOPATHY, PEDAL EDEMA 

BP- 110/70MMHG

 PR- 76BPM RR- 20CPM

 SPO2- 98% @RA 

CVS- S1 S2 HEARD

 RS- BILATERAL AIR ENTRY PRESENT + 

P/A- SOFT NON TENDER

 CNS- NO FOCAL NEUROLOGICAL DEFICIT

 Investigation HEMOGRAM,LFT,SR UREA,SERUM CREATINE,SERUM ELECTROLYTES,FBS,PLBS HBA1C 

Diagnosis ?OHA INDUCED HYPOGLYCEMIA

Treatment Given:

 1)IVF NS AND RL @75ML/HORLY 

2)GRBS MONITORING 4TH HOURLY

 3)BP,PR RR MONITORING 4 TH HOURLY 

4)INFORM SOS 

5 WITH HOLD OHA.

 6)TAB METFORMIN 500MG PO/OD 8AM 

7)TAB GLIMIPERIDE 1MG PO/OD 8AM 

9)TAB CINOD 10MG PO/OD 8AM 

Advice at Discharge 

1)TAB METFORMIN 500MG PO/OD 8AM 

2)TAB GLIMIPERIDE 1MG PO/OD 8AM 

3)TAB CINOD 10MG PO/OD 8AM

 Follow Up : REVIEW WITH FBS AND PLBS AFTER ONE WEEK

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