A 62 yr old with hypoglycemia

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.


A 62 year old female ,sweeper by occupation was apparently asymptomatic 30 days back .After 3 days of wearing anklets,she developed ulcer on right ankle -lateral side.she came to our hospital on 19 th july for ulcer and she was advised regular dressings with magnesium sulfate crystals and glycerine.As they couldn't do the dressings nor bring her to the hospital they took her to local RMP for dressings where they checked her previous reports showing FBS-183mg/dl and was advised Tablet containing Glimepride and Metformin .on August 3rd she had first episode of sweating,giddiness ,her family members felt that it might be due to low sugar levels and gave her biscuits and some sugar and she was alright.on 16 th August she took her medication after food at almost 11Pm.

At 1:00 pm she developed 2nd episode of sweating,giddiness,she was unable to speak and was brought in altered sensorium to KIMS casualty.GRBS when measured in casualty was 34mg/dl for which 25 D was given as bolus.

Past History:known case of Hypertension since 3 years on Telmisartan 20 mg ,known case of diabetes since 3 months.No h/o jaundice,T.B,asthma,CKD,CHD

Family History: No H/o Hypertension,D.M in family 

Drug History: Not allergic to any known drugs

Personal History: Diet : Mixed

                              Appetite: Normal

                              Sleep: Adequate

                  Bowel & Bladder: regular

                            No addictions

General examination:patient was in altered state with GCS- 13/15 ,moderately built and moderately nourished.

No pallor,no icterus,no cyanosis,nolympadenopathy,no pedal edema.

Vitals:

Afebrile

BP:150/100mmhg

PR:72 bpm

R.R: 12 Cpm

SPO2: 98%in R.A

GRBS:34mg/dl

Systemic examination:

CNS:pt is not  oriented to place and time,

         Memory is intact.

        Slurred speech

    Cranial nerve is intact.

   Motor system : 

                     Right.              Left

       Bulk :     N.                    N

      Tone:.     N.                    N

     Power:.   4/5.                 4/5

     Reflexes:

           Biceps:+2.              +2

          Triceps: +2.             +2

      Supinator:. +2.            +2

          Knee:.     +2.            +2

         Ankle:.     +2.           +2

        Plantar: flexion        flexion

Sensory system: Normal

No cerebellar signs

Cvs :s1 s2  present

Respiratory system:bilateral air entry present ,normal vesicular breath sounds heard,shape of chest normal 

Per abdomen:soft,non tender,all quadrants are moving equally with respiration,no organomegaly,bowel sounds are heard  Investigation:

GRBS charting

Treatment

25D/ iv /sos

T.telma 20 mg po/od

Bp,GRBS monitoring 2 hrly

Inj.ceftriaxone iv/od

Regular ulcer dressing

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