70 yr old female with altered sensorium and slurred speech

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 70 yrs old female bought to the casuality in unresponsive sate with cheif complaints of 


Slurring of since 1 day


Altered sensorium since 1 day 




HOPI : 


Patient was apparently asymptomatic 1 day back and on thursday morning she developed slurring of speech and giddiness then they went to a hospital in miryalguda , they found increased levels of sugars ( >500 mg/dl ) and thought giddiness was due to increased sugar levels and given treatment to reduce sugars, despite of which symptoms doesn’t relieved , on thursday night patient was bought to our hospital in unresponsive state. 


Blood in the stools 2 days back 


HCV +ve




Daily routine: 


Wake up - 8:00 am 


Completes her daily household activities 


Tiffin - 9:00am 


Lunch - 12:30 pm


Dinner-8:30 pm


Sleep - 9:30 pm




Past history : 


K/C/O - hypertension since 10 yrs ( on medication TELMA 20 mg ) 


K/C/O- Asthma 


Diabetes- diagnosed 1 day back ( 07-07-22) 


No history of epilepsy, thyroid,Tb . 




Personal history : 


Diet - mixed 


Appetite- normal 


Sleep - disturbed 


Bowel and bladder - regular  


Addictions - 


Toddy drinker 


Smokes bd 




Treatment history 


For hypertension- TELMA 20 mg 




GENERAL PHYSICAL EXAMINATION


Patient is unconscious 


Pallor :- 

Clubbing: 

Icterus :- 

Cyanosis :- 

Lymphadenopathy :-

Pedal Edema :-

Vitals 


BP -120/80 mmhg 


PR - 82BPM 




Systemic examination 


CVS - S1S2 + ve 


RS - BAE + 

P/A - soft 


CNS 




Tone Rt Lt 


           UL and LL hypertonic UL and LL hypertonia 






Investigations 





Provisional diagnosis 


Altered sensorium under evaluation 


Secondary to Acute CVA ? 




Treatment 


 


Iv fluids - NS /RL/ DNS - @70 ml/hr


Inj pan 40 mg - IV/OD


Inj optineiron - amp in 100 ml NS/IV/OD 


Inj THIAMINE 1 gm /IV/stat


BP/PR/SP O2 monitoring - 4 th hourly 


GRBS MONITORING - 


Tab TELMA 20 mg PO/OD 


Inj HAI S/C TID ACC to GRBS 

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