Case 5


 

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 i




70year old male resident of ghanakonda came in to casualty with chief complaints of Altered sensorium since 4am in the morning.patient was normal till 6pm in the night,then had dinner and felt uneasiness and took tab.GLIMI M2at around 7pm and had altered sensorium at around 8pm,then went to local hospital and found he was in hypoglycemia,then discharged at around 10pm.at 3:30am in the morning,patient attenders saw that patient was making gurgling sound and brought to KIMS for further evaluation.


PAST HISTORY:
K/c/o hypertension 
K/c/o DMT2


Not a k/c/o  CAD, asthma, TB, epilepsy.


PERSONAL HISTORY:
Patient has mixed diet with normal appetite and adequate sleep. 
he has normal bowel movements and bladder filling. 
No addictions. 

No significant family history or allergic history. 

GENERAL EXAMNATION:

No pallor, icterus, cyanosis, clubbing, lymphadenopathy, pedal edema. 
VITALS:
BP: 100/60 MMHG, 
PR: 100bpm 
Temp: 98.2°F
CVS: S1 ans S2 heard. No murmurs. 
CNS: Patient is alert,speech -aphasic,no meningeal signs.all reflexes  present.

INVESTIGATIONS:
1) HEMOGRAM : on 9/10/21
Hb: 15.6
TLC: 12100
N:80
L:11
PCV: 45.3
Mcv:84.7
MCH:29.2
MCHC:84.4
PLC:1.89
RBC:5.3



2)CUE
Alb:nill
Sug:nill
Ec:3-4Pc:2-3
RBC:nill

3)USG-
Raised echogenicity of both kidneys corelate with rft
4)serum electrolytes
Na+:141
K+:4.2
Cl-:101
4)serum creatinine-2.5mg/d
5)LFT
TB-1.23
DB-0.55
ALT-20
AST-25
TP-6.6
ALB-4.2
A/G-1.8
6)BLOOD UREA-78MG/DL
7)RBS-86
8)HBA1C-

PROVISIONAL DIAGNOSIS: RECURRENT HYPOGLYCEMIA 


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