38Y/F C/o HHS


This is an online e log book to discuss our patient identified health data shared after taking his/her guardian signed informed consent. Here we discuss our individual patient problems through a series of inputs from available global online community of experts with a aim to solve those patients clinical problem with collective current best evidence based inputs.

This blog also reflects my patient centered online learning portfolio and valuable inputs on the comments box is welcome.

I have been given this case to solve in an attempts to understand the topic of patient clinical data analysis, to develop my competency in reading and comprehending clinical data including history, clinical finding, investigation

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A 38 year old female hailing from choutuppal working as a sweeper in a chemical factory presented to the OPD with c/o fever since 3 days and weakness and tingling sensation in lower limbs since 3 days and 4 episodes of vomiting since 1 day.

History of present illness
-the patient was apparently asymptomatic 3 years ago , she was diagnosed with Hypertension after a routine health checkup she has been taking telmisartan 40mg daily ,
-4 days ago she complained of fever and inability to stand due to weakness ,
she was brought to the hospital by her family as she lost consciousness and couldnt recognise her family members , her RBS at time of admission was 610 mg/dl  
-she developed pitting edema in both lower limbs upon admission 4 days ago , it is relived on rest 

-image showing pitting edema upto knee



History of past illness 
-She was diagnosed with hypertension 3 years ago and is taking telmisartan daily 
-one year ago she spilled a chemical on her legs that led to ulcers , she got it bandaged at the hospital and it has completely healed leaving some black scars on both legs

 

-n/k/c/o : epilepsy , CAD , tb , asthma  

Personal history
married 
-occupation : sweeper at a chemical factory
-Diet : mixed 
-appetite : loss of appetite since 4 days 
-Bowels : regular
-Micturition : nocturia (1-3 times every night)
-Allergies : not known
-Addictions : none 

family history 
her father was diagnosed with DM2 and HTN 4 years ago during a routine health check up 

treatment history 
-telmisartan 40 mg daily since 3 years 

General examination
 
pallor : absent
icterus : absent 
cyanosis : absent
clubbing : absent 
lymphadenopathy : absent 
pedal edema : present , pitting type , upto knee

Vitals 
-temperature : 98.4 F
-pulse rate : 114/min
respiration rate : 22/min
-BP : 140/80mmHg
GRBS : 610 mg/dl
SPO2: 98%

systemic examination  
 
CVS 
thrills : no
cardiac sounds : S1 S2 heard
cardiac murmurs : no
 
RS 
Dyspnoea :no 
Wheeze : no
position of trachea : central
Bilateral air entry : present 
breath sounds : vesicular

ABDOMEN
shape : Scaphoid 
tenderness: no
palpable mass : no 
bowel sounds : heard

CNS 

Tone 
UL N  N
LL  N  N
 
power
UL 3/5  3/5
LL  3/5  3/5

REFLEXES
will ellicit today 


INVESTIGATIONS 

13-06-2022
RBS-610 mg/dl
blood urea - 180 mg/dl

electrolytes - Na : 127
                      -Cl : 90
                       -K : 4.3
urinary electrolytes : -Na : 95
                                       -Cl : 248
                                        -K : 13.1
Hb : 13.1
 
LFT   sgot : 10
          sgpt : 15
           alp : 266
             tp : 7.9
             al : 3.5 
            a/g : 0.72
              tb : 0.59
               db : 0.16
 HbA1c : 8

14-06-2022
ABG ; ph- 7.21
            pCO2- 20.1 
          pO2 - 87.5
           HCO3-7.8


20/06/2022

blood urea : 48
serum creatinine : 1.3
serum electrolytes : Na - 137
                                      K - 3.4
                                     Cl - 104
haemogram : Hb - 9.7gm/dl
                          platelet count : 1.33 lakh

21/06/2022
GRBS - 345 mg/dl 


SERUM ELECTROLYTES 
 
---------------------------
date  13/06/22      20/06/2022   normal values 

Na        127               137
K            4.3                 3.4
Cl          90                  104
-----------------------------
GRBS 

 22/06/2022
 12pm- 345 mg/dl 
  
fever chart 





provisional diagnosis : HHS - Hyperglycemic Hyperosmolar Syndrome 

treatment : doxycycline : 100mg BD 
                      DOLO 650mg PO/TID
                       ceftriaxone inj 1gm IV/BD 
                       Metrogyl inj IV/TID
                       piptaz 4.5 mg IV/BD
                       amitryptylline 10mg PO/OD
                       strict I/O charting 


CASE UPDATES 

provisional diagnosis : 
               HHS
              clinically diagnosed typhoid 
 treatment :
     amitryptyline 10mg PO/OD
       DOLO 650mg PO/BD 
      Pregaba 
      tepid sponging 
        temperature 2nd hourly 
      strict I/O charting  










 

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