PATIENT CAME WITH THE C/O SUDDEN UNRESPOSIVNESS

 Case History and Clinical Findings

SUDDEN UNRESPOSIVNESS SINCE 6PM ON 27/03/23

HISTORY OF PRSESNTING ILLNESS

PATIENT WAS APPARENTLY ASYMPTOMATIC 10 YEARS BACK THEN DEVELOPED GIDDINESS FOR WHICH HE WENT TO LOCAL HOSPITAL AN D WAS DIAGNOSED AS HAVING DIABETES AND HYPERTENSION ON MEDICATION SINCE THEN

HISTORY OF WEAKNESS OF LEFT UL AND LL 3 YEARS AGO DIAGNOSED AS CVA

15 DAYS AGO DEVELOPED COUGH WITH EXPECTORATION WHITE IN COLOR AND BILATERAL LOWER LIMB SWELLING INSIDIOUS ONSET GRADUALLY PROGRESSIVE AND FEVER LOW GRADE ON AND OFF SINCE 15 DAYS AND DEVELOPED SHORTNESS OF BREATH EVEN AT REST FOR WHICH HE WENT TO LOCAL HOSPITAL AND GOT AND TREATED WITH ANTIBIOTICS FOR 6 DAYS AND GOT DISCHARGED ON LAMA AND PATIENT SYMPTOMATICALLY IMPROVED AND SINCE EVENING 6 PM DEVELOPED SUDDEN ONSET UNRESPOSIVNESS

PAST HISTORY : KNOWN CASE OF TYPE 2 DM AND ON TAB GLIMI M2 2MG/500MG

AND HYPERTENSION SINCE 10 YEARS AND ON T MET-XL 25mg/PO/OD

K/C/O CVA3 YRS AGO AND ON TAB ECOSPIRIN AV

K/C/O CAD

PERSONAL HISTORY

DIET MIXED

APPETITE NORMAL

BOWEL AND BLADDER REGULAR

SLEEP ADEQUATE

FAMILY HISTORY NOT RELEVANT

GERNERAL EXAMINATION

O/E: PATIENT IS CONSCIOUS AND COHERENT

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

VITALS

TEMP:98.6F

PR:74 BPM

RR:18 CPM

BP:130/80 MM HG

GRBS - 33MG/DL AT PRESENTATION ,142MG/DL AFTER 25% DEXTROSE BOLUS

GCS - E2V1M5 AT PRESENTATION

CVS: S1 S2 HEARD , NO MURMURS

RS: BAE PRESENT , NO ADDED SOUNDS

P/A: SOFT, NON TENDER

CNS: PATIENT IS ORIENTED TO TIME PLACE AND PERSON

GCS E2V1M5

NO NECK STIFFNESS

NO KERNINGS SIGN

TONE RIGHT UL AND LL INCREASED

LEFT UL AND LL INCREASED

POWER RIGHT UL AND LL 5/5

LEFT UL AND LL 4/5

REFLEXES

BICEPS RIGHT AND LEFT POSITIVE

TRICEPS RIGHT AND LEFT POSITIVE

SUPINATOR RIGHT AND LEFT NEGATIVE

KNEE RIGHT AND LEFT POSITIVE

ANKLE RIGHT AND LEFT POSITIVE

PLANTAR RIGHT AND LEFT EXTENSOR RESPONSE


Provisional Diagnosis:-

ALTERED SENSORIUM [RESOLVED] SECONDARY TO OHA INDUCED HYPOGLYCEMIA [ RESOLVED ]WITH DILATED CARDIOMYOPATHY SECONDARY TO CAD WITH OLD CVA [ LEFT UL AND LL ]3 YEARS AGO WITH BILATERAL KNEE OSTEOARTHRITIS WITH HYPOKALEMIA WITH TYPE 2 DIABETES SINCE 10 YEARS WITH HYPERTENSION


Investigation:-

27-03-23

HEMOGRAM

HB 10.4

TLC 7800

PLATELET COUNT 1.71

PCV 31.2

RBC 3.65

30-3-23

HB 11.1

TLC 6200

PLATELET COUNT 1.56

PCV 33

RBC 3.82

31-3-23

HB 12.6

TLC 5900

PCV 37.4

RBC 4.33

PLATELET COUNT 2.02

1-4-23

HB 10.9

TLC 5400

PCV 33.4

RBC 3.84

PLATELET COUNT 1.99

2-4-23

HB 10.2

TLC 4900

PCV 30.9

RBC 3.55

PLATELET COUNT 1.9


2D ECHO:-

AORTIC VALVE CALCIFIED,THICKENED

RIGHT ATRIUM DILATED

RIGHT VENTRICLE DILATED

LEFT ATRIUM DILATED

LEFT VENTRICLE DILATED,RWMA LCX AKINETIC LAD RCA HYPOKINETIC CONCENTRIC LVH POSITIVE

EJECTION FRACTION 33 PERCENT

IVC SIZE 0.82cm COLLAPSING

IMPRESSION RVSP 48 PLUS 102 58mmHg

MODERATE MR/AR/TR WITH PAH

RWMA LCH AKINETIC LAD AND RCA HYPOKINETIC

SEVERE LV DYSFUNCTION NO MS

DIASTOLIC DYDFUNCTION , NO LV CLOT

CULTURE AND SENSTIVITY OF BLOOD - NO GROWTH AFTER 3 DAYS OF AEROBIC INCUBATION

USG -ABDOMEN AND PELVIS - NO SONOLOGICAL ABNORMALITY DETECTED


Treatment Given:-

INJ 25% DEXTROSE @30ML/HR

STOP OHA/ INSULIN

INJ LASIX 40MG IV/BD

T.ECOSPRIN AV 75 10MG/PO/ HS

T. MET XL 25 MG PO/OD

T.TELMA 40MG PO/OD

T. ALDACTONE 50MG PO/OD

SYRUP POTKLOR 15ML IN GLASS OF WATER/ TID

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