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



Comments

Post a Comment

Popular posts from this blog

63F Urinary incontinence 4 years ,RA on DMARD 25 years

Image
 A 65 year old Hindu woman a housewife a resident of west bengal having a Bsc degree and belonging to middle class according to modified kuppuswamy scale presented to the general medicine OPD with  chief complaints of  -constipation since the past 3 years  -continuous dribbling of urine since the past 4 years    History of presenting illness   Patient was apparently asymptomatic 26 years ago , when she developed continuous dull aching pain in both the knee joints , which was exaggerated in the mornings and was bearable throughout the day , it was aggravated on walking and relieved on rest  associated with redness around the knees no history of trauma no history of evening rise of temperature  no history of cosmetic deformity(varicosity, skin discoloration) -she underwent a bilateral knee replacement for knee stiffness  -is on DMARDS since 25 years  patient was incidentally diagnosed with hypertension 20 years ago during a follow up visit  -she was started on antihypertensive medicat
Read more

65Y/F CKD 2° MHD

Image
WARD CASE - 11th September 2023 A 65 year old uneducated lambadi woman a resident of Bhongir , working as a daily wage worker since 40 years earning 250 rupees a day , belonging to low socioeconomic status according to modified kuppuswamy scale presented to the general medicine OPD with chief complaints of : - swelling in both the legs since 15 days  - cough and shortness of breath since 10 days    History of presenting illness  Patient was apparently asymptomatic 6 months ago , when she developed swelling in the lower limbs which was insidious in onset and gradually progressive , it was associated with pain which was dragging in type and aggraveted on walking and working and was relieved on rest. -not associated with trauma  -not associated with any joint pains  -no history suggestive of previous filarial infection she was diagnosed with renal failure secondary to hypertension and started on dialysis    She has swelling of the lower limbs since 15 days which was insidious in onset and
Read more

MY EXPERIENCES WITH GENERAL CELLULAR AND NEURAL CELLULAR PATHOLOGY IN A CASE BASED BLENDED LEARNING ECOSYSTEM'S CBBLE

Image
  Greetings,  I am Anahita Behara a final year medical student from India .I welcome you to join me on my journey in navigating the topsy turvy road of learning in medical school.      CBBLE PAJR PARTICIPATORY LEARNING ACTION RESEARCH DISCLAIMER  NOTE: THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS/HER GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT.   I remember the first-time general medicine sparked interest in me .  Due to covid restrictions  our second year of medicine was conducted online .We had telephonic conversations with the patients to take their history and subsequently document elogs or online case logs. I vividly recall the case of a 70 year old woman with hypothyroidism who wa
Read more