202313738

 

 


Case History and Clinical Findings

SUDDEN UNRESPOSIVNESS SINCE 6PM ON 27/03/23 HISTORY OF PRSESNTING ILLNESS

PATIENT WAS APPARENTLY ASYMPTOMATIC 10 YEARS BACK THEN DEVELOPED GIDDINESS FOR WHICH HE WENT TO LOCAL HOSPITAL AN D WAS DIAGNOSED AS HAVING DIABETES AND HYPERTENSION ON MEDICATION SINCE THEN

HISTORY OF WEAKNESS OF LEFT UL AND LL 3 YEARS AGO DIAGNOSED AS CVA

 

15 DAYS AGO DEVELOPED COUGH WITH EXPECTORATION WHITE IN COLOR AND BILATERAL LOWER LIMB SWELLING INSIDIOUS ONSET GRADUALLY PROGRESSIVE AND FEVER LOW GRADE ON AND OFF SINCE 15 DAYS AND DEVELOPED SHORTNESS OF BREATH EVEN AT REST FOR WHICH HE WENT TO LOCAL HOSPITAL AND GOT AND TREATED WITH ANTIBIOTICS FOR 6 DAYS AND GOT DISCHARGED ON LAMA AND PATIENT SYMPTOMATICALLY IMPROVED AND SINCE EVENING 6 PM DEVELOPED SUDDEN ONSET UNRESPOSIVNESS

PAST HISTORY : KNOWN CASE OF TYPE 2 DM AND ON TAB GLIMI M2 2MG/500MG AND HYPERTENSION SINCE 10 YEARS AND ON T MET-XL 25mg/PO/OD

K/C/O CVA3 YRS AGO AND ON TAB ECOSPIRIN AV K/C/O CAD

PERSONAL HISTORY DIET MIXED APPETITE NORMAL

BOWEL AND BLADDER REGULAR SLEEP ADEQUATE

FAMILY HISTORY NOT RELEVANT GERNERAL EXAMINATION

O/E: PATIENT IS CONSCIOUS AND COHERENT

NO SIGNS OF PALLOR, ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY, EDEMA VITALS

TEMP:98.6F PR:74 BPM RR:18 CPM

BP:130/80 MM HG

GRBS - 33MG/DL AT PRESENTATION ,142MG/DL AFTER 25% DEXTROSE BOLUS GCS - E2V1M5 AT PRESENTATION

CVS: S1 S2 HEARD , NO MURMURS

RS: BAE PRESENT , NO ADDED SOUNDS P/A: SOFT, NON TENDER

CNS: PATIENT IS ORIENTED TO TIME PLACE AND PERSON GCS E2V1M5

NO NECK STIFFNESS NO KERNINGS SIGN

TONE RIGHT UL AND LL INCREASED

 

LEFT UL AND LL INCREASED POWER RIGHT UL AND LL 5/5 LEFT UL AND LL 4/5 REFLEXES

BICEPS RIGHT AND LEFT POSITIVE TRICEPS RIGHT AND LEFT POSITIVE SUPINATOR RIGHT AND LEFT NEGATIVE KNEE RIGHT AND LEFT POSITIVE ANKLE RIGHT AND LEFT POSITIVE

PLANTAR RIGHT AND LEFT EXTENSOR RESPONSE

Investigation 27-03-23 HEMOGRAM HB 10.4

TLC 7800

PLATELET COUNT 1.71

PCV 31.2

RBC 3.65

30-3-23

HB 11.1

TLC 6200

PLATELET COUNT 1.56

PCV 33

RBC 3.82

31-3-23

HB 12.6

TLC 5900

PCV 37.4

RBC 4.33

PLATELET COUNT 2.02

1-4-23

HB 10.9

TLC 5400

PCV 33.4

 

RBC 3.84

PLATELET COUNT 1.99

2-4-23

HB 10.2

TLC 4900

PCV 30.9

RBC 3.55

PLATELET COUNT 1.9

 

 

2D ECHO

AORTIC VALVE CALCIFIED,THICKENED RIGHT ATRIUM DILATED

RIGHT VENTRICLE DILATED LEFT ATRIUM DILATED

LEFT VENTRICLE DILATED,RWMA LCX AKINETIC LAD RCA HYPOKINETIC CONCENTRIC LVH POSITIVE

EJECTION FRACTION 33 PERCENT IVC SIZE 0.82cm COLLAPSING

IMPRESSION RVSP 48 PLUS 102 58mmHg MODERATE MR/AR/TR WITH PAH

RWMA LCH AKINETIC LAD AND RCA HYPOKINETIC SEVERE LV DYSFUNCTION NO MS

DIASTOLIC DYDFUNCTION , NO LV CLOT

CULTURE AND SENSTIVITY OF BLOOD - NO GROWTH AFTER 3 DAYS OF AEROBIC INCUBATION

USG -ABDOMEN AND PELVIS - NO SONOLOGICAL ABNORMALITY DETECTED

Treatment Given(Enter only Generic Name)

INJ 25% DEXTROSE @30ML/HR STOP OHA/ INSULIN

INJ LASIX 40MG IV/BD T.ECOSPRIN AV 75 10MG/PO/ HS

T. MET XL 25 MG PO/OD T.TELMA 40MG PO/OD

T. ALDACTONE 50MG PO/OD

 

SYRUP POTKLOR 15ML IN GLASS OF WATER/ TID

 

 

Advice at Discharge

STOP OHA/ INSULIN

T. LASIX 40MG IV/BD T.ECOSPRIN AV 75 10MG/PO/ HS

T. MET XL 25 MG PO/OD T.TELMA 40MG PO/OD

T. ALDACTONE 50MG PO/OD

SYRUP POTKLOR 15ML IN GLASS OF WATER/ TID

 

 


Comments

Post a Comment

Popular posts from this blog

Image
27 year old male with pain abdomen  July 20, 2022   THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT  27 year old male painter by occupation was brought to causality with chief complaints of pain abdomen . HOPI  Patient was apparently alright 40 days back then he developed pain and burning sensation in the abdomen which is squeezing type and diffuse all over the abdomen relieved after passing stools . Stool - frequency: 3 times a day , Small amounts , non blood , normal in consistency, mucoid ,non foul smelling , non floating and yellow in color  Not associated with fever , vomitings ,headache, burning micturation, SOB , cold&cough, chills and rigors. P
Read more

202308047

  Case History and Clinical Findings C/O ABDOMINAL DISTENSION SINCE 1WEEK C/O DECREASED APETTITE SINCE 1 WEEK C/O DECREASED URINE OUTPUT SINCE AFTERNOON PT WAS APPARENTLY ALRIGHT 1MONTH BACK THEN HE DEVELOPED PAIN ABDOMEN ON AND OFF , THEN HE DEVELOPED ABDOMINAL DISTENSION , WHICH WAS INSIDIOUS IN ONSET , GRADUALLY PROGRESSIVE IN NATURE .   NO H/O FEVER , NAUSEA , VOMITING ,LOOSE STOOLOS , CONSTIPATION HE HAD LOSS OF APPETITE SINCE 1 WEEK AND DECREASE IN URINE OUTPUT SINCE AFTERNOON. NOT A K/C/O DM ,HTN , ASTHMA , TB , CAD , CVA , EPILEPSY OCCASIONAL ALCOHOL INTAKE , NO H/O SMOKING . GENERAL EXAMINATION : PT IS C/C/C, MODERATELY BUILT AND NOURISHED NO SIGNS OF PALLOR , ICTERUS , CYANOSIS , CLUBBING , LYMHADENOPATHY , EDEMA AFEBRILE PR -120BPM BP - 130/80 MMHG RR - 20CPM SPO2 - 98% AT ROOM AIR GRBS - 108MG% CVS - S1S2 HEARD , NO MURMURS CNS-HMF INTACT . NFND RS -BAE PRESENT , NO ADDED SOUNDS P/A - ABDOMEN DISTENDED , UMBILICUS CENTRAL ,
Read more

DISSERTATION TOPIC

 TITLE:- Managing sarcopenia and visceral fat driven vascular outcomes in patients with diabetes  Problem statement/ Background: "Although obesity-related type 2 diabetes mellitus (T2DM) and sarcopenia have been increasing worldwide, the associations among visceral fat accumulation, skeletal muscle indices (mass, strength, and quality) and vascular outcomes in T2DM remain poorly investigated." Quoted from reference 1 :  https://cardiab. biomedcentral.com/articles/10. 1186/s12933-018-0755-3 Even while it's easy to qualitatively spot individuals with reduced limb muscle mass and trunkal fat it is important to establish that improving limb muscle mass and reducing trunkal fat utilizing diet and exercise strategies would improve cardiovascular outcomes in patients with diabetes mellitus.  AIM: To improve vascular outcomes in patients at risk of diabetes evidenced by their increased visceral fat and reduced muscle mass and strength   OBJECTIVES : • To assess various clinical a
Read more