Skip to main content

A case of light headedness caused by DKA

 This is an online E-log entry blog to discuss and understand the clinical data analysis of a patient, to develop competency in comprehending clinical problems, and providing evidence- based inputs in order to come up with a diagnosis and effective treatment plan to the best of my ability.

53yrs old female who is homemaker and resident of Cherlapalli complains of giddiness since 3 days and abdominal pain since 3days 

Case timeline: JUNE 2010:  Patient experienced giddiness following which she lost consciousness and attenders noticed a deviation of her mouth to right. No seizures were noted.

She was taken to a local hospital and was admitted in ICU where high blood sugar was detected and the patient was duly informed regarding her condition. She was discharged after 20 days after her admission in the general ward and was given insulin 

NOVEMBER 2010: She was once again reported to have uncontrolled blood sugar and was admitted in the general ward for 2 days following which she was prescribed oral hypoglycemic drugs and discharged. She has been on oral hypoglycemics since then.

APRIL 2021: The patient experienced giddiness and was taken to the hospital where she was diagnosed with a PCA stroke 

SEPTEMBER 2021: She reported the sudden onset of a headache which was continuos in nature. A CT scan was done

NOVEMBER 2021: A repeat CT was done in November 2nd for her persistent complaint about the headache.

NOVEMBER 24th: Patient was brought to our hospital and has been complaining of giddiness since 3 days, and transient abdominal pain since 3 days

 Tested on arrival: 

 FBS- 415

PLBS- 582

 HBA1C- 8.5

The patient did not want to get admitted so her medication was switched from OHA to tab glimi m2. BD 

since 3 days, patient has been on inj human mixtard- 12U----x----5U

no c/o fever, sob, cough, burning micturition.

K/c/o- DM2 on tab glimi m2 bd, on insulin since 3 days 

not a k/c/o htm, cva, ba, tb, epilepsy


PAST HISTORY

No similar complaints in the past.

H/o Diabetes mellitus since 10 years

History of PCA stroke 8 months ago

No H/o TB, HTN, Asthma, epilepsy


PERSONAL HISTORY

 Appetite:Normal 

Diet: Mixed

Sleep:Adequate 

Bowel and bladder:Regular 

No known drug allergies, addictions


GENERAL EXAMINATION

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

Moderately built and nourished. 

No pallor, icterus, cyanosis, clubbing, lymphadenopathy, edema. 


VITALS:

Temperature: Afebrile

PR: 77 bpm

BP: 130/80 mmHg

RR: 19 cpm

SpO2: 98%

GRBS: 584mg/dl


SYSTEMIC EXAMINATION:

RS: BAE+, NVBS+

CVS: S1, S2 heard, no murmurs

P/A: Distended, soft, non tender

CNS: NAD


INVESTIGATIONS:

1) ECG



2) CXR



PROVISIONAL DIAGNOSIS: 

An exacerbation of diabetic ketoacidosis in a 52 year old with a history of stroke in the posterior cerebral artery 8 months ago

TREATMENT:

INJ Avil 2cc iv stat 

INJ Levipil 1 gm iv stat 

INJ Zofer 8mg iv sos

INJ Pan 40 mg iv 

INJ HAI 6 unit iv stat followed by 6ml/hr infusion

GRBS charting hourly

Comments

Popular posts from this blog

A 48 year old male with seizures and altered sensorium

I have been given this case to solve in an attempt to understand the topic of “patient clinical data analysis” to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations, and come up with a diagnosis and treatment plan.   A 48-year-old gentleman hailing from a small town in Telangana presented to the casualty ward on 25th April 2021 at 7:40am with the chief complaints of unresponsiveness for 7 hours and 3 intermittent episodes of seizures in the past 3 hours HISTORY OF PRESENTING ILLNESS The patient was apparently asymptomatic 7 hours ago(at 1am) when he suddenly became drowsy and stopped responding to verbal instructions. Nearly 3 hours later (at 4am) he developed involuntary jerky movements on all four limbs, without regaining consciousness in between. He had 3 such episodes in total in a span of 3 hours. The duration of each episode is not known as the attendant failed to recollect the exact events He has a history of...

35 year old male with episodic cough

 Introduction: This is an online E-log Entry Blog to discuss, understand and review the clinical scenarios and data analysis of patients so as to develop my clinical competency in comprehending clinical cases, and providing evidence-based inputs.  Note: The cases have been shared after taking consent from the patient/guardian. All names and other identifiers have been removed to secure and respect the privacy of the patient and the family. Consent: An informed consent has been taken from the patient in the presence of the family attenders and other witnesses as well and the document has been conserved securely for future references.   A 35-year-old male presented with the chief complaints of episodic dry cough and noisy breathing since 7 months.  History of Presenting Illness: The patient was apparently asymptomatic 7 months ago when he first noticed a dry hacking cough and noisy breathing that was insidious in onset and gradually progressed to his current frequ...

46 year old female with a sudden distension of the abdomen

 This is an online E-log entry blog to discuss and understand the clinical data analysis of a patient, to develop competency in comprehending clinical problems, and providing evidence- based inputs in order to come up with a diagnosis and effective treatment plan to the best of my ability. A 46 year old female who is a resident of Chintakunta and an agricultural labourer by occupation was brought to the casualty with chief complaints of sudden distension of abdomen and difficulty in breathing since 1 week. History of presenting illness  2014 : The patient started experiencing pain in both her knee joints along with restricted mobility. She says it was starting then that she couldn't sit from a standing position or stand from a sitting position with ease anymore. 2021 : The patient was apparently asymptomatic 1 year back when she developed dyspepsia for which she was prescribed some PPIs which she started using on and off to treat her symptoms. The patient says she has develope...