47M Hypoglycaemic episodes secondary to DM since 10 years

 22/6/23.

Hi, I am SAI PRANEETH BATHINEEDI a medical student . This is an E-Log, that depicts the patient centered approach for learning medicine .This E-Log has been created after taking consent from the patient and their relatives. The links that were used by me for understanding the available data on the particular disease have been mentioned below in each post . Hope you learn valuable information after giving it a good read !

A 47Y/M driver by occupation, resident of lingotam came to casualty on 18/6/23 with chief complaints of;

Loss of consciousness since early morning 5am;

Burning micturition since 3 days;

History of presenting illness:

Patient was apparently asymptomatic 4 days back when he became unconscious and was brought to casualty (Grbs 35mg/dl) and was treated for hypoglycemia and he became responsive.

C/o of burning micturition since 3 days.

H/o similar complaints  1 week ago . Patient came to casuality with hypoglycemic episode ( was not willing for admission at that time) .

C/o fever,vomitings, loose stools 

No C/o sob, chest pain, palpitation, orthopnea, PND

No c/o pedal edema , facial puffiness, decreased urine output.
 
Past history:

Patient is k/c/o Diabetic Mellitus-II since 10 years on regular medication.

Patient had  bilateral Cataract surgery 9 years back.

Family history:

Not significant

Personal history:
  • Appetite - Decreased since hospitilization
  • Burning Micturation is present for the past 3 days  
  • Normal bowel and bladder movements
  • Sleep - adequate 
  • Diet - Non-Veg & Mixed (Veg) sometimes 
  • Chronic smoker since 20 years
  • No allergies.
General Examination:

Patient was conscious ,coherent , cooperative ,
well oriented.

Pallor-  present

Icterus-absent 

Cyanosis-absent 

Clubbing-absent

Lymphadenopathy-absent

Edema -absent


 Vitals:

Temperature-100.0'f 

Pulse rate -82bpm.

Bp-120/60mm hg 

RR-18cpm 

Spo2-99% . 

Grbs-184/mmHg


ABDOMEN EXAMINATION 

Soft non tender







Burn on Left Lower Quadrant 
Since childhood 





Dehydrated Tongue 



                  Pallor is present

Cvs system:

S1 and S2 sounds are heard.

No murmurs.

Respiratory system:

BAE present.

NVBS heard.


Investigation

                 18.06.2023












19.06.2023 to 21.06.2023







Ecg






Usg Abdomen


Provisional diagnosis:

Hypoglycemai secondary to oral hypoglycemic agents with k/c/o DM-2 since 10 years with ?diabetic nephropathy and associated anemia.


Treatment:

Iv fluids NS @ 100ml/hr strict I/o charting

 - stop oral hypoglycemic agents until further orders.

- inj. Neomol 1gm/iv/sos ( if temp>= 101F)

- inj. Zofer 4mg / iv/ sos

- inj. metrogyl 500mg /iv/ tid

- Tab sporolac 2 tabs po/tid

- Tab. baclofen 10mg /po/bd

- Tab dolo 650 mg PO/sos

- ors solution 200ml after every stool

-GRBS 7. Profile monitoring

-Vitals monitoring 2nd Hourly.
















Comments

Post a Comment

Popular posts from this blog

A 40 YEAR MALE WITH COMPLAINTS OF BOUTS OF VOMITINGS

Image
 01/12/23; This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input. This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome. Ihave been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan. A 40 years male, resident of chityala, field assistant by occupation came to the opd with chief complaints of vomitings Since 6:00pm yesterday; History of presenting illness: Patient was apparently as
Read more

OSCE AND LEARNING POINTS

OSCE QUESTION AND ANSWERS: 1) What is the mechanism of action of insulin at cellular level? Insulin acts on a glycoprotein- tyrosine kinase receptors on the cell membrane and it binds to the alpha subunit which leads to phosphorylation of beta subunit. This leads to transport of GLUT RECEPTORS on to the cell membrane which in-turn transports glucose into the target cell( adipocyte and muscle cell); Gluconeogenesis is inhibited and glycogenesis is stimulated in the liver cell with the action of insulin on it; All these leads to decrease in the blood sugar hence it usage in hyperglycaemic state; 2)How do you differentiate a patient clinically on the bedside whether the patient is type1 or type 2 diabetic? In type 1 diabetics the beta cells are 100% destroyed and hence supplemenation with secretagogues(hypoglycaemic drugs) would not benefit the patient clinically whereas in type 2 diabetics almost 10-30% of beta cells are functional hence we can boost them up with secretagogues and increa
Read more

A CASE OF ALTERED SENSORIUM UNDER EVALUATION PRIMARIY TO HEAD INJURY....ELOG BY SAIPRANEETH BATHINEEDI

Image
A CASE FROM GENERAL MEDICINE DEPARTMENT; 8 OCTOBER,2021 NAME:SAI PRANEETH BATHINEEDI ROLL NO:116 3RD SEM STUDENT; This is an online e log book to discuss our patient de-identified health data shared after taking his/her/guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evidence based input I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.  CHIEF COMPLAINT; A 55 YR OLD MALE PATIENT FARMER BY OCCUPATION CAME TO THE OPD WITH CHIEF COMPLAINTS OF WEAKNESS OF RIGHT SIDED UPPERLIMB AND LOWER LIMB WITH SLURRING OF SPEECH; HISTORY OF PRESENTING ILLNESS; The patient was a
Read more