HYPERGLYCEMIA



Unit 3:

Interns:

Dr .Leela 

Dr Harsha 

Dr Archana

Dr Kalyan 

Dr Sahithi 

Dr Jeehariki


Dr Raveen PGY1

Dr Aashitha PGY2

Dr Aravind PGY3

Dr Vamshi PGY3

Dr Hareen SR

Dr Praveen Naik Ass Prof

DR. RAKESH BISWAS HOD


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 patient's clinical problems with collective current best evidencebased inputs. 



This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.


Here is a case i have seen:

Admission under unit 3 on 27/01/2021 was a farmer By occupation 
presented to casualty with Complaints of  Deviation of angle of  Mouth to right side since one day
  Slurring of speech since one day which eventually subsided within few hours of presentation . 
Patient's long history of morbidity dates  10 years back. When he got diagnosed with Type 2 diabetes mellitus and was started on insulin.
He was on and off on it.
Due to financial constraints he was switched to OHAs in 2013 .
He was admitted in kamineni i/v/o  diabetic ulcer of right foot where daily aseptic dressings were done. He works as a farmer but  stopped working after developing diabetic ulcer. 
He recalls the history of hypoglycemic coma and later discharged over few weeks in 2017.
He was again admitted with similar complaints but this time in left foot and underwent daily dressings and was discharged over more than a month.
He gives a significant history of polyuria,over 7-8 times a day and have to wake 3 - 4 times in the wee hours.
He also gives history of polydipsia ( 3 jugs of water daily)polyphagia(he feels hungry every second hrly) 

On further probing patient gives further  history of tingling sensation +,burning sensation with pin pricking type of sensation over the plantar aspect of feet,hand and occasionally all over the body.. 

He gives a on and off history of SOB on exertion (grade 3) since 6-7.years. 

Also pedal edema which is pitting type,which didn't bother him to get a medical opinion. 
He is currently on Tab.METFORMIN PO OD
Tab.GLIMIPERIDE 2mg PO OD. 

K/c/o HTN since < 1 month.and is on tab.TELMA 40 PO OD.


RECENT HISTORY: 

He gives a history of low grade fever which subsided on medication. 
Along with H/o cough,dry cough occasionally for the past 4-5 days.
Since 2 days he has history of tingling and numbness in the lower part of upper limb and lower lip since yesterday.patient attenders observed Deviation of angle of mouth to the right 
Along with Slurring of speech till morning and subsided. 

He tells he has been having  diminished vision since the past few years and had been  limited to only counting finger test of 3-4 mts distance. 


On examination: 
Vitals: 
Temperature: 98.7  F
Pulse rate: 88 bpm
Respiratory rate: 18 cpm
BP:130/80mm of hg.
Spo2: 96%
GRBS: high.
SYSTEMIC EXAMINATION 
CVS: S1S2 heard.no murmurs. 
Lungs clear on auscultation 
CNS: 
Power 5/5 in all the limbs 
Proprioception  lost upto knees bilaterally 
Vibration reduced upto knees
Crude and fine touch, temperature - intact 
PER ABDOMEN: Soft and non tender.
Diagnosis -
? TIA
Uncontrolled blood sugars
Known case of type 2 DM since 10 years with diabetic triopathy - retinopathy, neuropathy,nephropathy

GRBS CHARTING 


INVESTIGATIONS :

Chest x ray.
ECG:


E CG:

Diagnosis-
Uncontrolled blood sugars - known case of type 2 Diabetes mellitus
Diabetic Triopathy - Neuropathy, nephropathy, retinopathy


Popular posts from this blog

28 year old male with unusual presentation

Image
Unit 3: Interns: Dr .Leela  Dr Harsha  Dr Archana Dr Kalyan  Dr Jeehariki Dr Raveen PGY1 Dr Aashitha PGY2 Dr Aravind PGY3 Dr Vamshi PGY3 Dr Hareen SR Dr Praveen Naik Ass Prof DR. RAKESH BISWAS HOD 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 patient's 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 the comment box is welcome. Here is a case i have seen today 17/2/2021 30 year old  year man presented to the casualty with the complaints of Fever on and off since the past 3 years Cough since 3 years Weight loss since the past 3 years Loss of appetite since 3 years Upper limb we...
Read more

65 yr female with heart failure and B/L pleural effusion and anemia

Image
Unit 3: Interns: Dr .Leela  Dr Harsha  Dr Archana Dr Kalyan  Dr Jeehariki Dr Raveen PGY1 Dr Aashitha PGY2 Dr Aravind PGY3 Dr Vamshi PGY3 Dr Hareen SR Dr Praveen Naik Ass Prof DR. RAKESH BISWAS HOD 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 patient's 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 the comment box is welcome. Here is a case i have seen on 17/2/2021 A 65 year old woman presented to the casualty with the complaints of Dyspnea at rest since 3 days Chest pain since 2 days Cough since 2days Patient works as a house wife and has had 3 normal vaginal deliveries. She has ...
Read more

bimonthly assessment march

Image
) Please go through the patient data in the links below and answer the following questions: https://ashakiran923.blogspot.com/2021/03/60-years-old-male-fever-under-evaluation.html?m=1 a). What is the problem representation of this patient and what is the anatomical localization for his current problem based on the clinical findings?How specific is his dilated superficial Abdominal vein in making diagnosis? Based on the clinical symptoms and signs, the clinical diagnosis of the patient can be-  UTI with cirrhosis of liver with portal hypertension.  b) What is the etiology of the current problem and how would you as a member of the treating team arrive at a diagnosis? What is the cause of his hypoalbuminemia?Why is the SAAG low?                 The etiology of the disease in this patient could be a chronic history of alcoholism. Chronic smoking leading to his apthous ulcers.  Based on his clinical finding there could be portal hyperte...
Read more