patirnt was apparently asymptomatic two days ago then yesterday morning at 8 am had generalized weakness and her mouth was deviated towards left and was taken local hospital where she was admitted and treated. her symptoms resolved by evening and was sent home. She did not take any of the medications at night
At 4am this morning patient was unable to get up from her bed and her mouth was deviated to left and was bought to our hospital.
she is a known case of Hypertension and type 2 diabetes since 3yrs and has been in medication since then regularly.
Metformin 500mg BD with glipizide
Telma ct 40/12.5 mg
personal history
patient used to work agricultural farm until 6 months ago
has a normal appetite with mixed diet.
bowel and bladder habits are regular
she used to consume alcohol occasionally 6 months ago(stopped since 6 months) and smoked beedi regularly until few yrs ago
she is not a known case of TB, BA, Epilepsy,
no surgical history
no significant family history
o/e
pt was conscious, drowsy
BP- 80/40
PR- 76
RR-18
TEMP- 98.9
SPO2-100 at room air
GRBS on arrival- 28mg/dl
CVS- S1 S2
RS- trachea- central, BAE+ NVBS+
PA- soft, non tender
CNS- Conscious, speechless
Reflexes- B T S K. A P
R +2 +2 +2 +2 +2 flexion L +2 +2 +2 +2 +2 flexion
Diagnosis- Recurrent Hypoglycemia secondary to Oral hypoglycemic agents with Chronic kidney disease. K/c/o
treatment-
IVF- 25% Dextrose at 20ml/hr
tab nodosis 500mg po/tid
tab shelcal ct po/od
tab orofer xt po/bd
inj erythropoietin 4000 iu s/c weekly once
withholding anti hypersensitives
Soap notes
ICU bed 5
Subjective
No fever spikes
Objective
On examination :
Pt is c/c/c
Oriented to t/p/p
No signs of pallor, icterus, cyanosis, clubbing, lymphadenopath
Vitalss
PR: 72 bpm, regular
RR: 20 cpm
BP: 100/70 mmHg
GRBS: 202 mg/dl
Systemic examination :
CVS:S1,S2 heard
Apex beat:5th ICS
Resp:
BAE+(vesicular breath sounds)
Nvbs heard
Position of trachea- central
P/A: soft, tenderness absent, bowel sounds heard
Cns: No focal deficit
Assesment- Recurrent Hypoglycemia secondary t8 OHAs with Croninc kidney disease secondary to?
K/C/O HTN amd type 2 DM
plan of treatment-
IVF NS, DNS @ 75ml/hr
INJ HAI S/C pre meal TID( 8AM-----1PM-----8PM)
Tab dolo 650mg po sos
tab orofer xt po bd
tab Nododsis 500mg po tid
tab shelcal ct po od
w/h OHA
tab amlog 50mg
Soap notes
ICU bed 5
Subjective
No fever spikes
Objective
On examination :
Pt is c/c/c
Oriented to t/p/p
No signs of pallor, icterus, cyanosis, clubbing, lymphadenopath
Vitals
PR: 66 bpm, regular
RR: 18 cpm
BP: 120/80 mmHg
GRBS: 98 mg/dl
Systemic examination :
CVS:S1,S2 heard
Apex beat:5th ICS
Resp:
BAE+(vesicular breath sounds)
Nvbs heard
Position of trachea- central
P/A: soft, tenderness absent, bowel sounds heard
Cns: No focal deficit
Assesment- Recurrent Hypoglycemia secondary to OHAs with Croninc kidney disease secondary to?
K/C/O HTN amd type 2 DM
plan of treatment-
IVF NS, DNS @ 75ml/hr
Tab dolo 650mg po sos
tab orofer xt po bd
tab Nododsis 500mg po tid
tab shelcal ct po od
tab amlog 50mg
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