PT CAME WITH BURNING SENSATION OF B/L PALMS

 PT CAME WITH BURNING SENSATION OF B/L PALMS SINCE 2 MONTHS HOPI: PT WAS APPARENTLY ASYMPTOMATIC TILL 2 MONTHS AGO THEN SHE NOTICED BURNING SENSATION OF B/L PALMS ,INSIDIOUS IN ONSET ,GRADUALLY PROGRESSIVE NOT ASSSOCIATED WITH TINGLING SENSATIONS ,NUMBNESS,PARESTHESIAS . NO H/O TRAUMA , NO C/O POLYPHAGIA,POLYDYPSIA ,POLYURIA NO C/O FEVER ,PAIN ABDOMEN,VOMITINGS,BURNING MICTURITION ,COUGH,COLD NO H/O MALENA,EXCESSIVE MENSTRUAL LOSS

 PAST HISTORY: K/C/O DM TYPE 2 SINCE 3YRS [ON REGULAR MEDICATION OF TAB GLIMI M1 ,PO/OD ] NOT A K/C/O HTN,CAD,CVA,EPILEPSY,THYROID DISORDERS ,TB,ASTHMA 

PERSONAL HISTORY DIET : MIXED

APPETITE : NORMAL
 BOWEL AND BLADDER : REGULAR
 ADDICTIONS : NONE 
SLEEP: ADEQUATE 
GENERAL EXAMINATION 
PATIENT IS CONSCIOUS /COHERENT/CO OPERATIVE 
PALLOR PRESENT 
NO  ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY,OEDEMA VITALS
 TEMP : AFEBRILE PR : 84 BPM RR: 18 CPM BP : 140/90 MMHG 
SYSTEMIC EXAMINATION 
CVS : S1,S2 HEARD ,NO MURMURS RS: BLAE PRESENT ,NVBS
 P/A : SOFT,NON TENDER
 CNS: NO FOCAL NEUROLOGICAL DEFICITS

 OPTHALMOLOGY REFERRAL ON 5/7/23 IMPRESSION:- NORMAL FUNDUS STUDY STRICT DIABETIC DIET ADVICED GLASSES FOR NEAR VISION GYNECOLOGY REFERRAL ON 5/7/23 
ADV : HVS[HIGH VAGINAL SWAB] REVIEW TO GYN DEPT AFTER HVS

PROVISIONAL Diagnosis :-
UNCONTROLLED SUGARS [K/C/O TYPE 2 DM SINCE 3YRS] 
IRON DEFICIENCY ANEMIA SECONDARY TO? NUTRITIONAL? BLOOD LOSS
 DENOVO HYPERTENSION

Investigation 
2D ECHO ON 5/7 TRIVIAL AR ,NO MR,TR NO RWMA ,NO AS,MS GOOD LV SYSTOLIC FUNCTION DIASTOLIC DYSFUNCTION IS PRESENT , NO PAH/PE

USG ON 5/7 
E/O 23X 16 MM OF HYPOECHOIC LESION NOTED IN ANT MYOMETRIUM 10X10MM HYPOECHOIC LESION IN POSTERIOR MYOMETRIUM OF UTERUS INTRA UTERINE FIBROIDS

INVESTIGATIONS ON 3/7 
HBA1C : 7.4 %
 SR.CREATININE : 0.6 MG/DL
 PLBS : 410 MG/DL
 FBS : 246 MG/DL 

CUE :-
ALBUMIN : TRACES
 SUGARS ;++++ 
PUS CELLS : 3TO 6 ON 4/7

 LFT :-
TOTAL BILIRUBIN - 0.83 
D.BILIRUBIN : 0.20 
SGOT : 16 IU/L 
SGPT : 13 IU/L 
ALP : 176 IU/L 
T.P- 8.2 GM/DL 
A/G RATIO - 1.24 
ELECTROLYTES SODIUM : 140 , 
POTASSIUM ; 4.1, 
CHLORIDE : 98 , 
CALCIUM IONIZED : 1.20 MEQ/L 

HEMOGRAM:- HB: 8.6 
TLC : 11,000 
N/L/E/M/B : 68/25/02/05/00
PCV : 30.7 
RBC : 5.28 
PLC: 2.77




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