33year old male with uncontrolled sugars

-



33year old male

diabetic since 7years used OHAs for 6years

and was started on inj.mixtard insulin as his sugars were uncontrolled on OHAs

pt is now on Inj.Human mixtard 20-15


Day before yesterday night pt had alcohol binge and did not eat ,so he did not take his insulin dosage following which

since yesterday mrng pt is having vomitings,3-4episodes yesterday,food as content

associated with generalised weakness ,giddiness since yesterday.so he did not take his insulin yesterday also


Since yesterday 3pm no futher episodes of vomitings but he is still feeling weak so they had brought him to casualty


No h/o fever,loose stools,pain abdomen

N/o cold, cough,shortness of breath


k/c/ o DM II since 7years on Mixtard insulin 

Not a klc/O HTN,CVA,CAD


Occasional alcoholic (take alcohol during festivals) 10years

Occasional smoker since 1month



O/E Pt C/C

BP 110/60

PR 120/min, regular

GRBS 417mg/dl

Spo2 98% at RA

CVs s1s2+,No mumurs

RS BAE +,NVBS









Diagnosis: Uncontrolled sugars


Treatment

IVF NS @100ml/Hr

InJ PAN 40mg IV stat

inj Zofer 4mg Iv stat

Inj HAI according to Grbs

7am-10am-2pm -4pm -8pm-10pm-2am

BP /PR monitoring



Comments

Post a Comment

Popular posts from this blog

QI PROJECT- IMPROVING POST-GRADUATE RESEARCH PROJECTS

-
Image
We, from the Department of General Medicine, at Kamineni Institute of Medical Sciences made high-quality research our top priority. Research within the field of General Medicine is crucial for advancing medical knowledge, improving patient outcomes, and implementing evidence-based medicine in practice. In our department, several research projects are currently underway, addressing a wide range of clinical issues. However, the effectiveness and efficiency of ongoing research projects can be significantly influenced by organizational and procedural frameworks within a department. Despite the commitment to high-quality research, various challenges have been identified that may hinder the successful completion and impact of these projects. The main challenge was insufficient research knowledge among post-graduates conducting the research. Their research needs improvements in terms of organizing the collected data and defining objectives and methodology to initiate with. Further improvement...
Read more

CLINICAL NEUROLOGY: THEORY TO PRACTICE-Teaching course

-
Image
 Teaching course-          “ CLINICAL NEUROLOGY”          “THEORY TO PRACTICE ” A well-organized teaching course in neurology was designed by me with the help of my fellow senior residents (Dr. Shashikala, Dr. Manasa, Dr. Pradeep, Dr. Vamshi, Dr. Manoj, Dr. Gouthami) with the support of our beloved HOD, Dr. Rakesh Biswas.  The main aim of this teaching course is to create interest among postgraduates in learning and teaching aspects of neurology. I planned to teach them on how to convert theoretical knowledge in neurology into practice.  I organized the course in such a way that each theory/seminar topic is followed by a relevant case presentation and journal. Postgraduates are trained in the theoretical aspects of the topic in the first class, and in the second class, the main focus is on examination techniques, making differential diagnoses, how to order appropriate investigations, and discussions on the management plan....
Read more

51 year old male with gaze palsy

-
Image
 NEUROLOGY DIARIES: 51 year old male ,Carpenter by occupation came with the chief complaints of  Inability to look at bright lights (R eye>Left eye) since 6months Decreased eyeball movements and slowing of activities since 6months Low volume of speech since 6months Stiffness of right upper limb since 6months HOPI:Patient was apparently asymptomatic 6 months ago.Since 6months patient has c/o inability to look at bright lights,Photophobia since 6 months,more in right eye compared to left eye associated with watering from eyes on sun exposure,not associated with redness of eyes or pain in eyes.No c/o discharge,burning sensation of eyes.c/o diplopia on looking at objects occasionally. Patients wife notices that patient has decreased eyeball movements in both eyes and patient is turning his entire head to look sideways and above and downwards. C/o slowness of activities with right upper limb such as eating and combing hair since 6months.Patient is taking food to the mouth slowly...
Read more