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.
















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