feve projr sle 30/F vasculitus 28310

 sle - 202228310

Diagnosis



HYPOGLYCEMIA SECONDARY TO ?ADRENAL INSUFFICIENCY WITH SLE WITH CNS VASCULITIS

Case History and Clinical Findings

Came to casualty yesterday with complaints of loss of consciousness since 30 mins after alleged consumption of T.Clonazepam 2mg ( 2 tablets ) with hypoglycemia ( 56gm/dl)Also complaints of polyarthritis since 4 months with morning stiffness in joints and pigmentation all over her face and ears since 3 months.Seizures - 1st episode 4 years back (sudden tragic loss of sister being the trigger) used medication2nd episode - after 6 months3rd episode - after one year4th episode - yesterday night ( lasted for 2 mins, post ictal confusion for 10 mins )since April, 2022 she stopped taking T.PREDNISOLONE and T.HYDROXYCHLOROQUINE after discharge from hopsital due to ? viral infectionICU bed no 4Day 1S: patient is responding to commandsC/o fever since 10 daysC/o oral ulcersO: o/e patient is opening eyes on vocal commandsPatient is able to understand and able to recognise their attendersUnable to speak making incoherent soundsBP - 100/70 mmhgPR - 110bpmCVS - S1S2+RS BAE+P/A softSpo2 - 96% at Room airShe is having wincing of her face flexing her neckGrbs - 60mg/dl at presentation after 25D --> 141 mg/dl5pm - 83mg/dlA: Altered sensorium secondary to Recurrent Hypoglycemia (?Adrenal insufficiency)

Treatment Given(Enter only Generic Name)

1.IVF NS @ 100 mL / hour .2.INJ Methylprednisolone 1gm in 100 mL IV3.Inj. Pan 40 mg IV/OD4.Inj. Neomol SOS5.T.Wysolone 40 mg PO/OD6.T.HCQ 200 mg PO/BD7.T.Levipil 500mg BD8.Oral candid cream9.vitals and grbs monitoring


Advice at Discharge

PATIENT AND ATTENDERS WERE EXPLAINED ABOUT THE CONDITION OF THE PATIENT IN THEIR OWN UNDERSTANDABLE LANGUAGE AND WERE REFERRED TO HIGHER CENTRE I/V/O IVIG AS HER COUNTS WERE IN DECREASING TREND AND AT THE DAY OF REFERRING HER TOTAL COUNTS WERE 930



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