70YEAR OLD MALE WITH RECURRENT HYPOGLYCEMIA

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A 70year old male resident of ghanakonda came in to casualty with chief complaints of Altered sensorium since 4am in the morning.patient was normal till 6pm in the night,then had dinner and felt uneasiness and took tab.GLIMI M2at around 7pm and had altered sensorium at around 8pm,then went to local hospital and found he was in hypoglycemia,then discharged at around 10pm.at 3:30am in the morning,patient attenders saw that patient was making gurgling sound and brought to KIMS for further evaluation.

PAST HISTORY:
K/c/o hypertension (on tab.TELMA met xl 40/50)po/od
K/c/o DMT2(On T.GLIMI ME /PO/OD)


Not a k/c/o  CAD, asthma, TB, epilepsy.


PERSONAL HISTORY:
Patient has mixed diet with normal appetite and adequate sleep. 
he has normal bowel movements and bladder filling. 
No addictions. 

No significant family history or allergic history. 

GENERAL EXAMNATION:

No pallor, icterus, cyanosis, clubbing, lymphadenopathy, pedal edema. 
VITALS:
BP: 100/60 MMHG, 
PR: 100bpm 
Temp: 98.2°F, 
SPO2: 95% 
RS: BAE+,NVBS,B/L IAA Crepts.
CVS: S1 ans S2 heard. No murmurs. 
CNS: Patient is alert,speech -aphasic,no meningeal signs.all reflexes  present.

INVESTIGATIONS:
1) HEMOGRAM : on 9/10/21
Hb: 15.6
TLC: 12100
N:80
L:11
PCV: 45.3
Mcv:84.7
MCH:29.2
MCHC:84.4
PLC:1.89
RBC:5.35



2)CUE
Alb:nill
Sug:nill
Ec:3-4Pc:2-3
RBC:nill

3)USG-
Raised echogenicity of both kidneys corelate with rft
4)serum electrolytes
Na+:141
K+:4.2
Cl-:101
4)serum creatinine-2.5mg/d
5)LFT
TB-1.23
DB-0.55
ALT-20
AST-25
TP-6.6
ALB-4.2
A/G-1.8
6)BLOOD UREA-78MG/DL
7)RBS-86

PROVISIONAL DIAGNOSIS: RECURRENT HYPOGLYCEMIA 

SOAP NOTES ON DAY 1 
S-
Pt sensorium has improved,
He is conscious,coherent
No fresh complaints

O-
Bp-140/80mmhg
Pr- 84bpm
Spo2- 98%
Cvs:s1s2heard
Rs: BAE+
P/A: soft

A-
Altered sensorium 2° to recurrent hypoglcemia 2° to OHA with Chronic kidney disease?? with k/c/o DM,k/c/o HTN.

GRBS:190mg/dl

Hb:14.8
Tc:10000
Platelets:1.51
P-
NBM till further orders
Ivf 25%dextrose@15-20ml/hr
Inj.PAN 40mg/iv/od
Ivf NS,RL @50ml/hr
Grbs monitoring hrly
Strict i/o monitoring
Inj.OPTINEURON 1amp in100ml ns/iv/od
Tab.nodosis 500mg/RT/BD
Tab.SHELCAL CT RT/OD
SOAP notesDay-2
S-
Pt sensorium has improved,
He is conscious,coherent
No fresh complaints

O-
Bp-130/90 mm hg
Pr- 80bpm
Rr-18cpm
Spo2- 98%
Cvs:s1s2heard
Rs: BAE+
P/A: soft

A-
Altered sensorium 2° to recurrent hypoglcemia 2° to OHA with Chronic kidney disease?? with k/c/o DM,k/c/o HTN.

GRBS:233mg/dl


P-
NBM till further orders
Ivf 25%dextrose@15-20ml/hr
Inj.PAN 40mg/iv/od
Ivf NS,RL @50ml/hr
Grbs monitoring hrly
Strict i/o monitoring
Inj.OPTINEURON 1amp in100ml ns/iv/od
Tab.nodosis 500mg/RT/BD
Tab.SHELCAL CT RT/OD
Tab.AMLONG 5mg RT
SOAP NOTES DAY 3
S-
Pt sensorium has improved,
He is conscious,coherent
No fresh complaints

O-
Bp-130/80mm hg
Pr- 82bpm
Rr-18cpm
Cvs:s1s2heard
Rs: BAE+
P/A: soft

A-
Altered sensorium 2° to recurrent hypoglcemia 2° to OHA with Chronic kidney disease?? with k/c/o DM,k/c/o HTN.

GRBS:193mg/dl


P-
Inj HAI s/c acc to grbs
8U (8am) - 6U (2pm) - 8U (8am)
Tab.PAN 40mg/ po/ od 1-x-x
Tab.SHELCAL CT RT/OD
Tab.AMLONG 5mg RT/OD


SOAP NOTES-Day 4
S-
Pt sensorium has improved,
He is conscious,coherent
No fresh complaints

O-
Bp-130/80mm hg
Pr- 82bpm
Rr-18cpm
Cvs:s1s2heard
Rs: BAE+
P/A: soft

A-
Altered sensorium 2° to recurrent hypoglcemia 2° to OHA with Chronic kidney disease?? with k/c/o DM,k/c/o HTN.

GRBS:193mg/dl


P-
Inj HAI s/c acc to grbs
8U (8am) - 6U (2pm) - 8U (8am)
Tab.PAN 40mg/ po/ od 1-x-x
Tab.SHELCAL CT RT/OD
Tab.AMLONG 5mg RT/OD


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