A 75 year old female with recurrent hypoglycemia secondary to OHA's with CKD
OCTOBER 23
This is an online e log book to discuss our patient identified health data shared after taking his/her guardian signed informed consent. Here we discuss our individual patient problems through a series of inputs from available global online community of experts with a aim to solve those patients clinical problem with collective current best evidence based inputs.This blog also reflects my patient centered online learning portfolio and valuable inputs on the comments box is welcome.I have been given this case to solve in an attempts to understand the topic of patient clinical data analysis, to develop my competency in reading and comprehending clinical data including history, clinical finding, investigation.
K.TEJA SREE , ROLL NO:54 , 9th SEM
CASE
A 75 year old female farmer by occupation came to the OPD with chief complaints of
deviation of mouth towards left and weakness since morning.
HOPI:
Patient was apparently asymptomatic 2 days back. When she developed weakness and deviating the mouth towards left side, she was admitted in local hospital yesterday and she was treated and discharged yesterday evening.
again since morning patient's mouth was deviating towards left and had generalised weakness so she was brought to the hospital.
History of intake of metformin 500 mg
HISTORY OF PAST ILLNESS:
known case of diabetes and hypertension since 3 years and on medications
- Metformin 500mg
- Telme
not a known case of TB, CAD.
PERSONAL HISTORY:
Appetite : Normal
Diet : mixed
Bladder & bowel : regular
Sleep :adequate
she drinks alcohol occasionally
no allergies
FAMILY HISTORY:
GENERAL EXAMINATION
- Pallor : absent
- Icterus : absent
- Cyanosis : absent
- Clubbing : absent
- Lymphadenopathy : absent
- Edema : absent
Vitals
- Pulse rate : 76bpm
- Bp : 90/60mmhg
- Temperature : afebrile
- Respiratory rate : 18cpm
- SpO2 : 99% at room air
SYSTEMIC EXAMINATION
- RESPIRATORY SYSTEM
-position of trachea: central
- normal vesicular breath sounds
-no dyspnea,wheeze
- CARDIOVASCULAR SYSTEM : S1, S2 heard and no thrills and no murmurs
- PER ABDOMEN : soft non tender non distended.
- CNS: higher motor functions are intact.
Cranial nerves ;
1) olfactory nerve ; percieves smell on both sides
2) optic nerve : normal visual acuity
3) occlomotor nerve ; normal
4) trochlear nerve ; normal
6) abducens nerve ; normal
(3,4,6 cranial nerves) ; ptosis,squint, nystagmus - absent.
* Ocular movements- present in upward,downward,temporal,nasal gaze
* Pupil- size- normal,shape- central
* Visual reflexes- direct, indirect- reacting to light
5) Trigeminal nerve ; cutaneous sensibility over skin and mucous membranes - present
✓ corneal reflex- present on both sides
✓ deviation of jaw on opening mouth- absent
7) facial nerve; normal
8) vestibuli cochlear nerve; normal
9) glossopharyngeal nerve; Taste sensation on posterior 1/3rd of tongue - present on both sides
✓palatal reflex- present on both sides
10)vagus nerve ; no history of regurgitation of fluids through nose
Palatal reflex- present
11) spinal accessory nerve ; normal
12) hypoglossal nerve ; normal
Motor system
Gait; normal
Power U/L L/L
Right 5/5 5/5
Left 5/5 5/5
Tone U/L L/L
Right increased increased
Left Normal Normal
Reflexes Biceps triceps supinator knee ankle
Right 2+ 2+ 2+ 2+. 2+
Left 2+ 2+. 2+. 2+. 2+
Pupil : reacting to light
Conjunctival reflex +
Corneal reflex+
Sensory system ; normal
INVESTIGATIONS:
On 23/10/2021
- serum creatinine - 3.5mg/dl
- serum electrolytes
- complete urine examination
- Glycated hemoglobin - 8.5%
- Hemogram
- Liver function test:
- colour doppler 2D echo
- Ultrasound
- ECG
- chest xray
- Recurrent hypoglycaemia secondary to oral hypoglycaemic drugs secondary to ?chronic kidney disease
- IVF 25% Dextrose @ 15ml/hr
- GRBS monitoring hourly
- Tab NODOSIS 500mg Po/TID
- Tab Shelcal CT po/OD
- Tab OROFER CT Po/BD
- INJ. Erythropoietin 4000IU SC weekly once
- Withhold anti HTN’s
- Inform SOS
- BP monitoring 2nd hourly
- IVF 25% Dextrose @ 15ml/hr
- GRBS monitoring hourly
- Tab NODOSIS 500mg Po/TID
- Tab Shelcal CT po/OD
- Tab OROFER CT Po/BD
- INJ. Erythropoietin 4000IU SC weekly once
- Withhold anti HTN’s
- Inform SOS
- BP monitoring 2nd hourly
- Withold OHA’s
