Skip to main content

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

Comments

Post a Comment

Popular posts from this blog

OSCE PREFINAL EXAM

 OSCE- PREFINALS DEC 2023: Case report :    I have tried to answer some of the questions regarding case discussion of our patient    1. How to clinically differentiate between coarse and fine crepitations ? Ans-  well, crepitations or crackles  are adventitious respiratory sounds which occur when an obstructed airway due to accumulated  secretions opens in inspiratory phase. The sudden opening of an obstructed airway causes an immediate re-equilibration of the pressures on both sides creating vibrations in the airway walls.  Fine crackles --  A).  having a short duration and a higher pitch,           Often, fine crackles are repetitive, originate          in the basal part of the lung, and not altered          by coughing. B) Coarse crackles  appear to be a longer                     durati...
Post a Comment
Read more

21

  Case History and Clinical Findings 57 YEAR OLD MALE PATIENT CAME WITH C/O OF SLURRED SPEECH 4PM ON 5/08/2023 C/O RIGHT UPPER LIMB &LOWER LIMB WEAKNESS SINCE 4PM. PATIENT PRESENTED TO CASUALITY WITH ALTERED SENOSIRUM SINCE 4PM HOPI: PATIENT HAS A H/O SLURRED SPEECH AND H/O RIGHT UPPER LIMB AND LOWER LIMB WEAKNESS SINCE THEN ASSOCIATED WITH FALL. NO LOC, NO ENT BLEED NO H/O FEVER, BURNING MICTURITION, LOOSE STOOLS NO H/O SOB, PALPITATIONS, ORTHOPNEA, PND HISTORY OF PAST ILLNESS: NOT A K/C/O HTN,DM,EPILEPSY, THYROID DISORDERS. O/E: GCS-E5 V4 M5 BP- 90/60MMHG PR- 68BPM CVS- S1S2 + RS- NVBS + SPO2- 97% ON RA CNS- TONE: RIGHT LEFT UL INCREASED INCREASED LL INCREASED INCREASED POWER: UL &LL COULDNT ELICIT REFLEXES: B +++ ++ T + + S + + K - + A - - P FLEX FLEX PUPILS- B/L CONSTRICTED, SLUGGISH REACTIVE COURSE OF ADMISSION: PATIENT WAS ADMITTED I/V/O ABOVE MENTIONED COMPLAINTS. NECESSARY INVESTIGATIONS WERE DONE. MRI FINDINGS- ACUTE INFARCT IN LEFT CAUDATE AND LE...
Post a Comment
Read more

10

  Case History and Clinical Findings A 50 YEAR OLD MALE WITH C/O COUGH SINCE 20 DYAS,FEVER SINCE 1 WEEK SHORTNESS OF BREATH SINCE 5 DAYS BILATERAL PEDL EDEMA SINCE 30 DAYS DECERASED URINE OUTPUT SINCE 1 DAY ALTERED SENSORIUM SINCE 8 HRS PATIENT WAS APPARENTLY ASYMPTOMATIC 20 DAYS AGO THEN HE DEVELOPED COUGH SINCE 20 DAYS,PRODUCTIVE TYPE WITH YELLOWISH WHITE COLOURED SPUTUM,SCANTY IN NATURE,NOT BLOOD TINGED AND FOUL SMELLING FEVER SINCE 1 WEEK,LOW GRADE,NOTT ASSOCIATED WITH CHILLS AND RIGORS SHORTNESS OF BREATH SINCE 5 DAYS INSIDIOUS IN ONSET AND GRADUALLY PROGRESSIVE PROGRESSED FROM GRADE 2 TO GRADE 4.ORTHOPNEA PRESENT NO PND. BILATERAL PEDAL EDEMA SINCE 3 DAYS,DECREASED URINE OUTPUT ,N/H/O VOMITINGS,LOOSE STOOLS,PAIN ABDOMEN K/C/O HTN SINCE 3 YEARS NOT ON REGULAR MEDICATION CKD SINCE 6 MONTHS ON CONSERVATIVE MANAGEMENT PERSONAL HISTORY : DIET :MIXED APPETITE : GOOD SLEEP : ADEQUATE BOWEL:REGULAR ALCHOL ISTORY- OCASSIONAL SINCE 20 YEARS STOPPED 6 MONTHS BACK GENERAL EXAMINATI...
Post a Comment
Read more