55 year old female patient with anasarca evaluated for hypoglycemic attack

This is an online E log book 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 series of inputs from global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centred online learning portfolio and your valuable inputs on the comment box is welcome."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 a diagnosis and treatment plan




CHIEF COMPLAINTS

A 55 year old female was brought to casualty at 1:00 am in the night on 26/12/2021 with 
C/o sudden unresponsiveness since 1 hour.
C/o Generalised swelling & abdominal distension since 10 days.



HOPI: Patient was apparently asymptomatic 1 hour back.She took her inj.Human Mixtard 23U and had her dinner and slept,later patients attenders observed that she was snoring and sweating excessively and tried to wake her up,but she was unresponsive,then they checked her GRBS which was 35 mg/dl.

No H/o seizures, head trauma, headache
No c/o decreased urine output,fever.
No c/o orthopnea,PND


PAST HISTORY

K/c/o DM and is on Inj.Human Mixtard 
    34U-------X-------23U

DENOVO HTN ,used medication for 2 days and stopped.

Not a k/c/o TB, Epilepsy, Asthma,CAD


PERSONAL HISTORY

DIET: Mixed
APPETITE: Normal
B&B: Regular
ADDICTIONS: No addictions

FAMILY HISTORY- Not significant.

GENERAL EXAMINATION
 
Patient 

Mild Pallor
No Icterus
No cyanosis
No Clubbing
No Lymphadenopathy.

Generalized edema - anasarca + 



 Right toe 

Vitals:
          BP: 130/90 mm hg
          PR: 56 BPM
          Temp: 98 F
          Spo2: 98% @ RA
          GRBS: 34 mg/ dl

 SYSTEMIC EXAMINATION.
   CVS: S1 S2 +, NO MURMURS
   RS: BAE+, Normal Vesicular breath sounds heard.
   P/A: SOFT, DISTENDED , BS+
   CNS: GCS- E1 V1 M1, pupils reactive

     Patient was given  IVF 25% D after which patient is C/C/C, Oriented to time,place and person.

                       R.              L.
POWER.        Normal.    Normal.   
TONE            Normal.    Normal.  
 


Investigations :

   
Day 3
C/o anasarca+
Previous c/o urine output subsided 
No episodes of hypoglycemia 


Pt is c/c/c
BP- 120/80 mmhg
PR- 76 bpm
Grbs- 180 mg/dl
CVS- S1 S2+
RS- BAE+
CNS- No FND, HMF intact

Provisional Diagnosis : 

Diabetic retinopathy with nephropathy
Rt Great toe ?Chronic osteomyelitis ?Fungal origin
Hypoglycaemia (?Iatrogenic)

Treatment :

1. GRBS monitoring 2nd hrly
2. Inj.HAI S.C TID acc to grbs(premeal)
3. T.NICARDIA 10mg PO BD
4. T.PAN 40mg PO OD
5. FUDIC CREAM L/A 
6. T.AUGMENTIN 625mg PO BD
7. T.METROGYL 400mg PO TID
8. T.CHYMORAL FORTE PO TID

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