71 year old male with hypoglycemia
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Name : Ankitha
Roll no : 78
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 diagnosis
11/03/23
71 year old male patient presented to the casuality with complaints of unresponsiveness at 6am in the morning
HOPI :
Patient was unresponsive since 6 am in the morning and was taken to local hospital and his grbs was found to be 40mg/dl and was treated with 25D iv fluids and improved symptomatically and was referred to higher centre
Patient is a known diabetic and before this incident he was using Glicazide 60mg and metformin 500mg regularly
5 days back after his routine checkup he was adviced to use glimiperide 2mg from now on .
Patient attenders thought glimiperide tablet as a part of att treatment and used it along with glicazide and metformin they were previously using since 4-5 days and today morning patient developed unresponsiveness.
When He came to our hospital grbs was 63mg/dl and was started on 25D i.v fluid and treated symptomatically.
Patient was apparently asymptomatic 3months back then he developed fever, cough with sputum , generalised weakness and loss of appetite and went to local hospital , where he got treated but symptoms did not resolve and on further investigations he was diagnosed with tuberculosis and was started on ATT (HRZE) (on 6/12/22)
and after 3-4 days patient developed skin reactions (dermatitis ) and so patient went to local hospital and was given medication but did not resolve and finally he was shifted to rifampicin 450 mg and INH 300mg from the past 25 days as the patient developed itching towards ethambutol and pyrazinamide
Patient didn’t take the ATT Medication regularly
From the past 2 months
PAST HISTORY :
K/c/o TB since 2months ( Sputum positive - Pulmonary TB )
K/c/o Type 2 Diabetes mellitus since 3 years (on Glicazide 60mg and metformin 500mg )and glimiperide 2mg once daily started since 4-5 days
K/c/o hypertension since 10 years ( on telma 40mg and metoprolol 47.5mg )
H/O Hernia surgery 6 years back
PERSONAL HISTORY :
SYSTEMIC EXAMINATION :
CARDIOVASCULAR SYSTEM:
Inspection:
Shape of chest is elliptical.
No raised JVP
No visible pulsations, scars , sinuses , engorged veins.
Palpation :
Apex beat - felt at left 5th intercostal space
No thrills and parasternal heaves
Auscultation :
S1 and S2 heard.
RESPIRATORY SYSTEM:
Inspection:
Shape- elliptical
B/L symmetrical
Both sides moving equally with respiration .
No scars, sinuses, engorged veins, pulsations
Palpation:
Trachea - central
Expansion of chest is symmetrical.
Vocal fremitus - normal
Percussion: resonant bilaterally
Auscultation:
bilateral air entry present
Wheeze present
PER ABDOMEN :
Inspection :
Umbilicus is central and inverted
All quadrants are moving equally with respiration
No sinuses , engorged veins, visible pulsations .
Hernial orifices are free.
Palpation :
Soft, Non tender
No organomegaly.
Liver and Spleen - Not palpable
Percussion : Tympanic note heard over the abdomen.
Auscultation :
Bowel sounds are heard.
CENTRAL NERVOUS SYSTEM:
Conscious,coherent and cooperative
Speech- normal
No signs of meningeal irritation.
Cranial nerves- intact
Sensory system- normal
Motor system:
Tone- normal
Power- bilaterally 5/5
Reflexes Right Left
Biceps ++ ++
Triceps. ++. ++
Supinator ++ ++
Knee. ++. ++
Ankle ++. ++
INVESTIGATIONS :
Tb :
HRCT DONE OUTSIDE : 29/11/22
13/03/23
PROVISIONAL DIAGNOSIS :
Hypoglycemia secondary to ? OHA induced
TREATMENT :
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