202305850

 

 

Case History and Clinical Findings

CHIEF COMPLAINTS:

C/O SHIVERING SINCE MORNING C/O SWEATING SINCE MORNING HOPI:

 

PATIENT WAS APPARENTLY ASYMPTOMATIC 4 MONTHS BACK THEN SHE HAD SWEATING, BREIF LOSS OF CONSCIOUSNESS AND WENT TO LOCAL HOSPITAL DIAGNOSED WITH HYPOGLYCEMIC EPISODE. SHE HAD SIMILAR TWO EPISODES IN THE MIDNIGHT 1 DAY BACK. SHE WAS BROUGHT TO OUR HOSPITAL FOR FURTHER MANAGEMENT.

PAST HISTORY:

H/O SIMILAR EPISODE IN THE PAST 4 MONTHS BACK. K/C/O DM SINCE 5 YEARS (ON GLIMI M1)

NOT A K/C/O HTN, EPILEPSY, TB, ASTHMA, THYROID. GENERAL EXAMINATION:

PATIENT IS CONSCIOUS, COHERENT AND COOPERATIVE.

NO PALLOR, ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY. EDEMA OF FEET PRESENT.

VITALS AT ADMISSION: TEMPERATURE: AFEBRILE PR:112BPM

RR:24CPM BP:180/110MMHG SPO2:100% GRBS:38MG/DL SYSTEMIC EXAMINATION:

CVS: S1 S2 PRESENT NO MURMURS RESPIRATORY SYSTEM:

NORAML VESICULAR BREATH SOUNDS HEARD PER ABDOMEN:

SHAPE OF ABDOMEN : OBESE SOFT AND NONTENDER

CNS: NFND

VITALS AT DISCHARGE : BP:140/80MMHG PR:82BPM GRBS:90MMHG

COURSE IN THE HOSPITAL:-

 

47YEAR OLD FEMALE, KNOWN DIABETIC SINCE 5YEARS IS ON TAB.GLIMI M1 1/2TAB OD, WITH RECURRENT HYPOGLYCEMIC EPISODES PRESENTED TO OUR CASUALTY FOR FURTHER MANAGEMTNENT. ON EVALUATION, HER METABOLLIC PROFILE SHOWED GRBS- 38MG/DL. INJ. 25% DEXTROSE IV BOLUS AND WAS MAINTAINED AT INJ.25% DEXTROSE IV @10ML/HR.

ON NEXT DAY INJ. 25%DEXTROSE WAS TAPERED DOWN TO 2.5ML/HR.LATER WAS CONVERTED TO PLENTY OF ORAL FLUIDS

GASTROENTEROLOGY OPINION WAS TAKEN FOR HETEROECHOIC LESION IN LIVER SEGMENT IV A AND ADVISED FOR AFP,CEA AND TRIPHASIC CT SCAN AND BIOPSY UROLOGY OPINION WAS TAKEN FOR B/L HYDROURETRONEPHROSIS AND WAS ADVISED

NON CONTRAST CT-KUB.

OPTHALMOLOGY OPINION WAS TAKEN FOR HYPERTENSIVE AND DIABETIC RETINOPATHY AND NO CHANGES WERE SEEN

GYNECOLOGY OPINION WAS TAKEN FOR B/L HYDROURETRONEPHROSIS AND TRANSVAGINAL SONOGRAPHY WAS DONE AND NO ABNORMALITY DETECTED PATIENT IS BEING DISCHARGED IN HEMODYNAMICALLY STABLE CONDITION.

 

Investigation

HB-8.6-7.4-7.1-7.8GM/DL

TLC-7,900-6,600-6,400-7,000CELLS/CUMM PLT-2.52-2.47-2.27-2.18LAKHS

 

2D ECHO:

MILD MR+; TRIVIAL TR+; NO MR NO RWMA. NO AS/MS

GOOD LV SYSTOLIC FUNCTION DIASTOLIC DYSFUNCTION +; NO PAH/PE REVIEW 2D ECHO: 8/2/23

NO RWMA MILD LVH+

MILD AR+; TRIVIAL TR+/MR+ SCLEROTIC AV, NO AS/MS EF=58; RVSP:35MMHG

GOOD LV SYSTOLIC FUNCTION DIASTOLIC DYSFUNCTION+, NO PAH/PE IVC SIZE (0.81CMS) COLLAPSING

 

USG:6/2/23 RT.KIDNEY-11*5.2CM

LEFT KIDNEY- 10.8*5CM

E/O HETEROECHOIC LESION IN THE LIVER SEGMENT 4 A , LIKELY MALIGNANT ETIOLOGY B/L HYDROURETERO NEPHROSIS

RIGHT COMPLEX CYST IN KIDNEY.

INTERNAL ECHOES SEEN WITH BLADDER WALL THICKENING ?CYSTITIS CORRELATE WITH CUE.

 

REVIEW USG I/V/O CORTICAL THICKNESS:

IMPRESSION:

B/L MODERATE HYDROURETERONEPHROSIS SIGNIFIACNT PVR

 

TRANSVAGINALSONOGRAPHY 11/2/23 UTERUS:-6.3*2.6CM

ET-2-3MM MYOMETRIUM-NORMAL

OVARIES-NOT VISUALISED POUCH OF DUGLUS-NIL

 

AFP-1.50 CEA-1.86

 

Treatment Given(Enter only Generic Name)

INJ 25% DEXTROSE IV @15 ML/HR (INCREASE OR DECREASE TO MAINTAIN GRBS 200- 250MG/DL)

IV FLUIDS 1 NS AND 1 RL @ 125 ML/HR TAB CILNIDIPINE 10 MG PO/OD

SYP CREMAFFIN PLUS PO/H//S 10 ML WITHHOLD OHS

Advice at Discharge

1. TAKE PLENTY OF ORAL FLUIDS

 

2. TAB CILNIDIPINE 10 MG PO OD AT 8AM

3. TAB OROFER XT PO/OD AT 2PM FOR 1 MONTH

3. SYP CREMAFFIN PLUS PO/HS 10 ML AT 9PM BEDTIME

4. WITHHOLD ORALHYPOGLYCEMIC DRUGS


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