A 47Y/M driver by occupation, resident of lingotam came to casualty on 18/6/23 with chief complaints of

Loss of consciousness since early morning 5am;

Burning micturition since 3 days;

History of presenting illness:

Patient was apparently asymptomatic 4 days back when he became unconscious and was brought to casualty (Grbs 35mg/dl) and was treated for hypoglycemia and he became responsive.

C/o of burning micturition since 3 days

H/o similar complaints  1 week ago . Patient came to casuality with hypoglycemic episode ( was not willing for admission at that time) .

C/o fever,vomitings, loose stools 

No C/o sob, chest pain, palpitation, orthopnea, PND

No c/o pedal edema , facial puffiness, decreased urine output.

Past history:

Patient is k/c/o Diabetic Mellitus-II since 10 years on regular medication.

Patient had  bilateral Cataract surgery 9 years back.

Family history:

Not significant

Personal history:

Appetite - Decreased since hospitilization

Burning Micturation is present for the past 3 days  

Normal bowel and bladder movements

Sleep - adequate 

Diet - Non-Veg & Mixed (Veg) sometimes 

Chronic smoker since 20 years

No allergies.

General Examination:

Patient was conscious ,coherent , cooperative ,

well oriented.

Pallor-  present

Icterus-absent 

Cyanosis-absent 

Clubbing-absent

Lymphadenopathy-absent

Edema -absent

 Vitals:

Temperature-100.0'f 

Pulse rate -82bpm.

Bp-120/60mm hg 

RR-18cpm 

Spo2-99% . 

Grbs-184/mmHg

ABDOMEN EXAMINATION 

Soft non tender









 


Burn on Left Lower Quadrant 
Since childhood 





Dehydrated Tongue 



                  Pallor is present

Cvs system:

S1 and S2 sounds are heard.
No murmurs.

Respiratory system:

BAE present.
NVBS heard.

Investigation

                 18.06.2023












19.06.2023 to 21.06.2023







Ecg






Usg Abdomen


Provisional diagnosis:

Hypoglycemia secondary to oral hypoglycemic agents with k/c/o DM-2 since 10 years with ?diabetic nephropathy and associated anemia.

Treatment:

Iv fluids NS @ 100ml/hr strict I/o charting
 - stop oral hypoglycemic agents until further orders.
- inj. Neomol 1gm/iv/sos ( if temp>= 101F)
- inj. Zofer 4mg / iv/ sos
- inj. metrogyl 500mg /iv/ tid
- Tab sporolac 2 tabs po/tid
- Tab. baclofen 10mg /po/bd
- Tab dolo 650 mg PO/sos
- ors solution 200ml after every stool
-GRBS 7. Profile monitoring
-Vitals monitoring 2nd Hourly.

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