70 yr old female with altered sensorium and slurred speech

-

 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 

Comments

Post a Comment

Popular posts from this blog

76 Female with hemiballismus secondary to uncontrolled sugars

-
Image
 A 66 yr old female ,residence of nalgonda came to the old with c/o  Slurring of speech since 15days Involuntary movements of right upper limb since 10days And right lower limb since 5 days She was apparently asymptomatic 15days ago then she developed swelling of tongue f/b slurring of speech , insidious in onset and gradually progressive,no aggravating and relieving factors Not associated with deviation of mouth  C/o involuntary movements of right upper and lower limb,insidious in onset and gradually progressive , aggravating on increasing sugars and decreasing with decrease in grbs levels She also c/o skin lesions over genital region since 15days Past history: K/c/o HTN since 2 years K/c/o DM since one week  She has h/o joint pains( shoulder and elbow) since 2-3 months for which she went to a local hospital and the reports shower RA FACTOR+  and was advised tab . methotrexate (on regular medication) Personal history: Diet :mixed  Appetite:normal  Bowel and bladder:regular but c/o bu
Read more

76 year old female with hemiballismus secondary to uncontrolled sugars

-
Image
  This is an online e log book to discuss our patient de-identified health data shared after taking his / her /  guardians signed informed consent. Here we discuss our individual patients problems through series of  inputs from available global online community of experts with an aim to solve those patients clinical  problem with collective current best evident based input. This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the  comment box is welcome. I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis"  to develop my competency in reading and comprehending clinical data including history, clinical findings  investigations and come up with diagnosis and treatment plan . Unit 1 Amc bed 1 DOA 22/5/23 A 66 yr old female ,residence of nalgonda came to the opd with c/o  Slurring of speech since 15days Involuntary movements of right upper limb since 10days And right lower li
Read more

45 M with Abdominal distension and b/l lower limb swelling

-
Image
This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input. This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome. I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings investigations and come up with diagnosis and treatment plan. Unit 1  AMC bed 5 DOA:29/5/23 45 year old male ,lorry driver by occupation,resident of Nalgonda came to the opd with chief complaints of       Abdominal distension since 4-5 days      Abdominal bloating since 4-
Read more