61 yr old male with loss of consciousness

 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.



CHIEF COMPLAINTS

A 61yr old male came with chief complaints of brief loss of consciousness 3 days back. His GRBS on admission was 39mg/dl. After connecting on 25D he regained his consciousness.
H/o of vomiting 1 episode 

HISTORY OF PRESENTING ILLNESS

Patient was apparently asymptomatic 3 yrs back Then he developed weakness for which he went to hospital & diagnosed with HTN & was started on Tab. TELMA- AM but was on irregular medication. Then he was fine till yesterday night. Then he had dinner & took HTN medication. Then he suddenly had brief loss of consciousness for 2 hrs. According to the patient he took 2 tablets that day after taking dinner

PAST HISTORY 

K/c/o HTN Since 3 yrs ( not on regular medication) 
Not a k/c/o DM , TB , EPILEPSY

PERSONAL HISTORY:

Moderately built and nourished.
Sleep normal.
Appetite is normal.
Bowel and bladder are regular.
He occassionally takes alcohol.

GENERAL EXAMINATION 

Patient is conscious, coherent and cooperative 

NO PALLOR , ICTERUS, CLUBBING , CYANOSIS , LYMPHADENOPATHY , EDEMA

VITALS ON DAY OF ADMISSION 
PR- 62bpm
RR -18cpm
TEMP -98.3°F
BP- 110/70 mmHg

GRBS- 39mg%
SPo2-  98%on room air

SYSTEMIC EXAMINATION 

•CVS : S1 and S2 heart sounds heard .No murmurs and thrills
•RESPIRATORY SYSTEM : Bilateral air entry present                                             position of trachea - central
                                       Vesicular breath sounds heard
•CNS : NAD
•ABDOMEN : Soft and non tender
              No palpable masses
              Bowel sounds heard 
              No organomegaly
    
                   

       




He has cellulitis 2° to stasis eczema and ulcer over the right leg since 1 month for which swab was taken for culture and sensitivity and gram negative organisms were isolated.
                         

INVESTIGATIONS










ECG 

Vitals



Arterial And Venous Doppler 

                           


MRI brain
                            


Provisional Diagnosis: 
hypoglycemia secondary to OHA under evaluation.
 
Plan of treatment 
1. Stop OHA
2. IV fluids 25% dextrose infusion @ 10ml/ hr
3. Hourly GRBS monitoring
4.tab. telma 40mg po/od
5. Megaheal ointment for leg ulcer/tid
6. Bp/pr/temp monitoring 8th hourly .

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