A 61 Year old male with hypoglycemia

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 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.

A 61 year old male came to casuality with the chief complaints of loss of consciousness 3 days back , his GRBS at the time of admission is 39 mg/dl.

HOPI:patient was apparently asymptomatic 3 days back ,then he developed loss of consciousness after taking drugs for hypertension ,according to him he told that he took 2 tablets that day after taking dinner

patient gives a history of hypertension 3 years back,from then he is taking medication but not regularly.

PAST HISTORY 

K/c/o HTN Since 3 yrs ( not on regular medication) ,DM
Not a k/c/oTB , EPILEPSY,CAD,ASTHMA

PERSONAL HISTORY: MIXED DIET
Sleep normal.
Appetite is normal.
Bowel and bladder are regular.
He occassionally takes alcohol.

GENERAL EXAMINATION :

Patient is conscious, coherent and cooperative ,well oriented to time,place and person ,he is moderately built and nourished.

NO PALLOR , ICTERUS, CLUBBING , CYANOSIS , LYMPHADENOPATHY , EDEMA

VITALS ON DAY OF ADMISSION 
PR- 62bpm
RR -18cpm
TEMP -98.3°F
BP- 110/70 mmHg

GRBS- 39mg%
SPo2-  98%on room air

SYSTEMIC EXAMINATION 

CVS : S1 and S2 heart sounds heard .No murmurs and thrills
RS: Bilateral air entry present,normal vesicular breath sounds,
position of trachea : central
CNS: No focal neurological deficits
P/A: Abdomen is soft,non tender,no organomegaly,shape of the abdomen - saphoid,no scars,sinuses

Bowel sounds are heard

MRI BRAIN:




complete urine examination:

 

Arterial and venous doppler:


complete blood picture:


ECG: 

RENAL FUNCTION TESTS:






ulcer over right leg,with eczema

Provisional Diagnosis: 

hypoglycemia secondary to OHA under evaluation.
 
Plan of treatment 
1. Stop OHA
2. IV fluids 25% dextrose infusion @ 10ml/ hr
3. Hourly GRBS monitoring
4.tab. telma 40mg po/od
5. Megaheal ointment for leg ulcer/tid
6. Bp/pr/temp monitoring 8th hourly .

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