60Year old female patient came to causality with chief complaints in drowsy state since 2hours

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 available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs. This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome


60Year old female patient came to causality with chief complaints in drowsy state since 2hours .

HOPI:-

Patient was apparently asymptomatic 3years back, due to back pain and bilateral knee pain pt used NSAIDS &HERBAL medication for pain,used to have NSAID'S intermediately for pain.
45 days back patient had thron prick injury, below Lt medial malleolus, went to local hospital for non healing status resolved after 1month diagnosed with DM & HTN started on TELMAH &GLIMI-M1 .

4days back, went for DM check up and came to know about CKD.
 pt was taken GLIMI-M1 for 3days, last dose on 05/02/22@8 pm
Since yesterday pt was c/o drowsiness since 8pm and again since 9pm .
she is c/o drowsiness.c/o vomitings 2episodes a/w food particles today@10pm,c/o SOB at rest, grade 3 to4

PAST HISTORY:-
k/c/o DM, Hypertension since 1month

PERSONAL HISTORY:-
Appetite- decreased since 3day 
Diet- mixed
Bowel and bladder movement-regular
Micturition- decreased since 1day 
Addictions: -occasionally alcoholic since 10years
Homemaker - no  physical activities 

O/E:-

Pt was c/c/c

No pallor, icterus ,cyanosis,clubbing lymphadenopathy ,oedema

Temp:-afebrile

 PR-98bpm

RR-22cpm

Bp-180/100mmhg

Spo2-98%

Grbs-21mgdl , after 2@25 D IV GRBS 312mg/dl


CVS-s1s2 heard,no murmurs

Rs- BAE+,NVBS+

P/A- soft, non tender


INVESTIGATION:-

CHEST X RAY
ECG
Other
CUE
2D ECHO

USG


PROVISIONAL DIAGNOSIS:-
HYPOGLYCEMIA 2° TO OHAS , NSAID INDUCED NEPHROPATHY


TREATMENT:-

1)Inj.10D Infusion maintain GRBS 150-200mg/dl

2) Hourly GRBS monitoring

3)BP,PR,RR,TEMP Charting 4th hourly

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