A 65yr old M with Hypoglycemia,Hypotension

 A 65 yr old male patient, resident of miryalguda came with chief complaints of 

Hypoglycemia.


Pt came with  Hypoglycemia with Grbs 30mg/dl.


Pt came to the surgery department with c/o multiple ulcers over lt leg since 6 months.

Pt was apparently asymptomatic 6 months back then he developed 4 small ulcers of size 1x 1 cm initially, which was gradually increasing to attain present size.H/o fever which was on and off. Then he suddenly developed Hypoglycemic symptoms and became unconscious  and transferred to medicine department.No H/o trauma 

H/o Fracture at left elbow joint which was ill treated - Non union of Fracture 30 yrs back.

Pt is a K/C/O of DM and is on regular medication - T. Glimestarmil PO/OD

Had H/o pulmonary cox 2 yrs ago.

N/K/C/O HTN,Asthma,Epilepsy. 


Married

He worked as a Sarpanch in his village.

Have Normal appetite with mixed diet and regular bowel and bladder movements. 


No significant family history 


General examination 

Pt is c/c/c . 

No pallor,Icterus, Clubbing,Cyanosis, Lymphadenopathy, oedema.

Temp : Afebrile

Pulse Rate : 82 bpm

Bp : 110/80mmhg

RR : 18 cpm

Spo2 : 97% On RA

Grbs : 101 mg/dl 


Systemic examination 


RS : 

decreased  air entry on left side,NVBS + ,No crepts. 


CVS : 

s1 s2 + ,No murmurs 


CNS : NFD 


ABDOMINAL EXAMINATION  


Inspection : 

Abdomen flat

Moves with respiration

no abdominal distension

umbilicus is central and  inverted 

no engorged veins

no scars,sinuses,

hernial ornifices are clear 


Palpation

All inspectory findings are confirmed

No tenderness

Percussion

No significant findings 

Auscultation 

Bowel sounds heard

No bruits 


Local examination - ulcer over lt lower limb 


Inspection: 


An ovoid ulcer of size 8x 6cm over lower 1/3 of lateral aspect of left leg with well defined margins with sloping edges with pale granulation tissue with slough with floor as underlying muscle.

An oval ulcer of 2x1cm over lt ankle region on lateral aspect with well defined margins 

with sloping edges with pale granulation tissue with scab with floor as underlying muscle.

A vertically oval ulcer of size 4x 2cm over lateral aspect of lt ankle region with well defined margins with sloping edges with pale granulation tissue with floor as underlying muscle.

An ovoid ulcer of size 4x3 cm over medial aspect of lt ankle region with well defined margins with sloping edges with pale granulation tissue with floor as underlying muscle with minimal slough.

Surrounding skin is pigmented. 


Palpation: 


Tenderness + 

All inspectory findings are confirmed, base of all ulcers are formed by underlying bone.


Clinical images




Investigations 




4/9/23



3/9/23




2/9/23









1/9/23
















Diagnosis : Recurrent Hypoglycemia (resolved) 2° to Sepsis / OHA with Septic shock (resolved) with renal Acute kidney injury 2° to ulcer over lt leg with type 2 DM with true hyponatremia (resolved) with severe anemia ,rt upper lobe and middle lobe pneumonia with lt pleural effusion with consolidation.



T/t : 

IV fluids NS @50ml/hr 

Inj. Meropenem 500mg/IV/BD 

Inj. Pan 40mg /IV /OD

Inj. PCM 650 mg /IV/SOS 

T chymerol Forte/PO/BD

T Vit C /PO/OD

Syp Ascoril LS 10ml /PO/TID 

Oint Thrombophobe for L/A

Dressing over lt lower limb

Grbs 4th hrly monitoring

Pr,Rr,spo2 1hrly monitoring 

Comments

Post a Comment

Popular posts from this blog

Image
 A 58 year old male, labourer by occupation, came to the OPD with the chief complaints of Shortness of breath since 30 days,which was worsened 1 day back(19/02/22), chest pain since 30 days ,facial puffiness since 30 days History of Presenting illness -   Patient was apparently asymptomatic 3 years ago then developed giddiness,  for which he went to a local hospital and was diagnosed as Hypertensive, for which he is taking T. Nicardia 10mg, T. Arkamine 0.1mg sos. Then 2 years back he  developed B/L pedal edema,  which progressed gradually to knees and  diagnosed with renal failure, started dialysis weekly twice. Since 4 months he developed left upper limb swelling and swelling at chest region,both of  which got  progressed to current size.  Back pain since 2 months, which got subsided on medication (T. Ultracet).  30 days back - he developed shortness of breath ,Grade II-III  which progressed to Grade IV since 30 days associated with orthopnea . Whereas from 4 days he developed right u
Read more

1801006077 SHORT CASE

Image
 A 40 year old female patient ,hotel owner, resident of Narketpally came with chief complaints of Increased heartbeat since 6 months Breathlessness since 6 months HISTORY OF PRESENT ILLNESS : Patient was apparently asymptomatic 6 months back then she developed palpitations which were sudden in  onset, gradually progressive and develops under stress, heavy work. It lasts for 2 to 3 min and relives on rest . Since the last 2 to 3 months she complains of increased frequency and intensity of palpitations. She also complains of breathlessness ( shortness of breath) since 6 months and it was gradually progressive from grade 1 (6 months back)to 3 (presently)and it relieves on rest. Patient also has fainting attacks , headache when there is delay in food intake or prolonged standing and it gets relieved on taking rest or food. PAST HISTORY Not a known case of Diabetes, Hypertension, Asthma, Tuberculosis,Epilepsy, Thyroid disorders. Has acidity from past 15 years. She develops burning sensation
Read more