55y old male with metabolic syndrome with recurrent hypoglycemia secondary to OHA



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:

A 55 old male came to casualty on 1/12/2020 at 3:20 pm with c/o of Sob ( grade 2-3) which is insidious on onset , progressive , increased on exertion since 3 days c/o cough since 3 days not associated with sputum 

no h/o fever, chest pain, loss of weight, loss of appetite, palpitations, syncopal attack, burning micturition, diarrhoea, constipation, abdominal pain

pt suddenly complained of giddiness , profuse sweating with grbs- 34 mg/dl

past history- 

k/c/o DM 2 since 10 yrs and on oral hypoglycemic drugs Glimi M1 OD mixtard 30/70 20 units OD

Htn since 10 yrs and is on Telma AM 40/2.5 mg

No h/o hepatic, renal, cardiac failure 

no H/o gastric surgeries

no previous episodes of hypoglycemia

no pain abdomen / pancreatitis ( for pancreatic tumors ) 

Personal history-

diet - mixed 

appetite - normal

sleep - adequate

bowel and bladder- regular

General examination: patient is conscious, coherent, cooperative 

No pallor, icterus, cyanosis, clubbing,lymphadenopathy,

pedal edema is seen

Vitals:

Pulse: 84bpm

Respiratory rate: 28/ min

Bp: 120/70 mm hg

Systemic examination: 

Cvs: S1 S2 heard no additional sounds or murmurs

Rs: NVBS, bae+

Abdomen: distended

Cns: higher mental functions intact 


provisional diagnosis-

Recurrent hypoglycemia secondary to OHAs with morbid obese k/c/o  DM2 and HTN since 10 yrs with metabolic syndrome





Hemogram 
lipid profile 
Glycated haemoglobin 
Serum electrolytes ( Na cl  k)
Serum creatinine 
urine protein/ cretinine ratio 
urinary sodium 
urinary potassium 
 Urinary chloride 
Serum potassium 
ABG
RFT
LFT
T3 T4 TSH
ECG
chest x ray
GRBS CHARTING 
01 /12/2020 
02/12/ 2020

03/12/2020
INJ.AUGUMENTIN 1.2 GM IV BD
INJ 25 D BOLUS IF GRBS LESS THAN 40 MG/DL
INJ HUMAN ACTRAPID INSULIN S/C TID
8 AM(8U) ,2PM(8U)  ,8PM(6U )
TAB LASIX 40MG PO /BD IF SBP > 110MM OF HG
TAB PANTOP 40 MG PO OD AT 7 AM
SYRUP LACTULOSE 10 ML PERORAL TID
BP, PULSE,SPO2, GRBS CHARTING 4 TH HRLY
STRICTLY I/0 CHARTING 
FREQUENT SMALL FEEDS 

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