50 /F HYPOGLYCEMIA SECONDARY TO OHA ASSOCIATED WITH CKD STAGE (|||B)

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 patient's clinical problems with collective current best evidence based inputs


This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.


Here is a case I have seen. 


INTERNS 
juveria 
Swarna 
Nikhil 
Manivarma
Divya


Dr. Arjun. (ASSIS PROF) 
PGs
Dr. Manasa PGY1
Dr. RADHA PGY3

50 year female came to casualty in semi conscious state, patient was apparently asymptomatic 8 years back then she had low grade fever went to hospital on routine blood investigation and examination diagnosed as hypertensive and diabetes 2 since 8 years on treatment with Atenolol 50 mg amlodipine 5 mg glimepiride 2mg p o o d 4 months back she is developed pedal edema gradual in onset progressive in nature fitting type extending up to knee no history of chest pain palpitations s o b fever cough burning maturation facial puffiness today she came to casualty in semi conscious state with profuse sweating . 
On examination:
 pupils NSRL 
pulse :84 beats per minute 
BP 130 / 100 mmhg
 grbs 38 MG DL. 
Cvs: S1S2 heard 
Resp :NVBS +
P/A :SOFT 
CNS: NAD 
PITTING TYPE OF PEDAL EDEMA 

respiratory rate :22 cycles per minute 
spo2 : 98% 
intravenous fluid 25% dextrose given IV 
        ⬇⬇⬇
grbs ➡ 122 MG/DL  . 

Personal history 
Married, housewife 
Diet :non veg 
Appetite decreased since 1 month. 
Bowels regular
No burning micturation
No known allergies
Addiction/habits :
betel nut  and betel leaf taking since 30 years( 2 to 3 per day) after food
 
CNS examination :
patient is drowsy, speech is slurred 
no signs of meningeal irritation 
Glasgow  scale E1 V2 M5

Pedal edema -pitting type upto knee 

INVESTIGATION 


ECG

CHEST XRAY

USG ABDOMEN AND PELVIS


Treatment 
Day 1
       25% Dextrose IV /SLOW (GRBS 38 mg/dl) 
    IVF 10% D @ 100 ML /HR 
   INJ. CEFTRIAXONE 1GM IV /BD
   INJ. PANTOP 40 MG IV/OD 
   GRBS AND BP MONITORING  HOURLY

DAY 2 
 IVF 5 % D AT 50 ML/ HOUR
INJ. CEFTRIAXONE 1 GM IV /BD 
TAB. PANTOP 40 MG PO/OD 
TAB ATENOLOL 50 MG PO/OD AT 8 AM
GRBS MONITORING 4 TH HOURLY 
STOP OHA UNTIL FURTHER INSTRUCTIONS. 

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