A 65years Female with Uncontrolled sugars.

 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 CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUT.

Chief complaints:

A 65 years old female came to the opd with chief complaints of high grade fever since 10days and Difficulty in walking and b/L lower limb weakness since 1week.

History of presenting illness:

Patient was apparently asymptomatic 10years back due to decreased appetite she went to hospital and diagnosed to have type 2DM from then she is on OHA’s.

Since one week she is having high grade fever which is associated with chills and rigor.

Decreased food intake and missing OHA’ssince 10days.

She also have difficulty in walking and B/L lower limb weakness.

She is passing stools and urine in her cloths due to weakness in both the lower limbs since 10days.

Past history:

K/C/O Diabetes since 10years and she in on OHA’s

K/C/O Hyperthyroidism since 20years and she is on Neocarbimole.

Not a k/C/o of Hypertension,Asthma,CAD,epilepsy.

Family history:

Not Significant.

Personal history:

She is housewife and stays alone at home since 5years after her husband expired.

She alone does all the work at home.

Physiological habits:

Diet-mixed

Sleep-adequate 

Appetite-decreased 

Bowel and bladder movements-irregular

Addictions-none

General physical examination:

Patient is conscious ,coherent and cooperative and well oriented to time, place and person.

moderately built and nourished

No pallor icterus, cyanosis, clubbing, No Generalised lymphadenopathy, No b/l pedal edema.

Vitals:

Temperature - 100.2*c

PR :- 80 bpm

RR :-18 cpm

BP :- 110/70 mm Hg

SPO2 :- 98%

GRBS :- 560 mg / dl

Systemic examination:

CVS -S1 S2 Heard , no murmurs heard 

CNS - no focal neurologic deficit 

RESPIRATORY - bilateral air entry present 

PER ABDOMEN - tenderness in the left hypogastric region.

Investigations:

ABG.

PH -7.347

pco2-28/mmhg 

Po2-81/mmhg

So2-93.9%

HCO3-16.9mmol/lit

GRBS-592mgdl

18/8/22

Hemogram:

Hb-7.8gm/dl—> to 8gm/dl 

TLC-5700

Lymphocytes-17cells/mm*3

Eosinophils-2

Monocytes-3

Basophils-0

PCV-24.2

MCV-84.9

MCH-27.4

MCHC.32.2%

RDW.CV-16.2%

RDW.Sd-51.1%

Rbc count-2.85millon/mm*3

Platelets-1.3

Smear-normocytic normochromic.

No hemoparasites.

LFT

TB: 0.79mg/dl

DB: 0.16mg/dl

SGOT-22IU/lit

SGPT-17IuU/lit

ALP: 108

TP: 5.6

A: 2.3

A/G: 1.72

RFT:

UA : 8.6

S.crt:1.6

Urea:70mg/dl

Ca++:4

Na: 1.34

K+:4

Cl-:102

Urine for ketone bodies-negative

CUE:

Colour-pale yellow

Appearance-cloudy

Reaction-acidic

Specific gravity-1.010

Alb-postive

Sugar- +++

Bile salts -nil

Bile pigments-bile

Pus cells-8-10

Epithelial cells-1-2

Rbc-1-2

Crystals and cast-nil

Bacteria-present.

Culture reports:

USG:

No sonological abnormality detected.

X ray:

Provisional diagnosis:

Uncontrolled diabetes-Type2

Diabetic ketoacidosis?

1.IVF 10 NS 

10 5%dextrose @100ml/hr

2.INJ.Magnex forte 1.5 gm iv bd

3.BP/PR/RR/GRBS charting-2nd hourly

4.Intermittent NIV

5.INJ.PIPTAZ 4.5gm/IV/BD

6.TAB.AZITHROMYCIN 500 mg/PO/OD

7.INSULIN as per GRBS 

8.NEBULISATION WITH BUDECORT DUOLIN 6th hourly

21/8/22

S:SOB subsided, fever subsided

O: No fever spikes since yesterday 

Patient is conscious,coherent and cooperative

PR-72bpm

RR-22cpm

BP-120/80mm Hg

Temp-98.°F

GRBS trend 

6am-89mg/dl  

8am - 4units HAI given 

2pm- 292mg/dl 10 units given 

10pm-143mg/dl 6 units given 

CVS-S1 and S2 +,no added sounds

R/S-BAE+,wheeze

P/A-soft and non tender

A:uncontrolled sugars with type 2 DM

    Right lower lobe consolidation

P:

1)Inj piptaz 4.5gm iv bd 

2)inj pan 40mg iv

3)tab azithromycin 500mg Po OD

4)BP/pr/RR every 4th hourly 

5)tab dolo 650mg Po tid

DAY 7

ICU BED NO-3 65 YEAR OLD FEMALE

Admitted on 16/08/2022

22/08/2022

S:SOB subsided, fever subsided

O: No fever spikes since yesterday 

Patient is conscious,coherent and cooperative

PR-102bpm

RR-cpm

BP-120/60mm Hg

Temp-98.°F

GRBS trend 

8am-194mg/dl  

2pm- 237mg/dl 

4pm-128mg/dl 

8pm-284mg/dl 10 units

CVS-S1 and S2 +,no added sounds

R/S-BAE+,wheeze

P/A-soft and non tender

A:uncontrolled sugars with type 2 DM

    Right lower lobe consolidation

P:

1)Inj piptaz 4.5gm iv bd 

2)inj pan 40mg iv

3)tab azithromycin 500mg Po OD

4)BP/pr/RR every 4th hourly 

5)tab dolo 650mg Po tid

1. nebulisation Duolin buds per 12 th hrly
2. Tab glimi m1 Po/od @ 8 am
3. High protein diet 2 egg whites / day
4. Tab livogen 120 mg Po/bd