65M with altered sensorium secondary to hypoglycaemia

 

 65 YEAR OLD MALE PATIENT FARMER BY OCCUPATION HAD BROUGHT TO CASUALITY IN ALTERED SENSORIUM SINCE 2HRS ON 27/11/2022 AT 8:00PM.

November 27, 2022
A 65 YEAR OLD MALE PATIENT FARMER BY OCCUPATION HAD BROUGHT TO CASUALITY IN ALTERED SENSORIUM SINCE 2HRS ON 27/11/2022 AT 8:00PM.

HOPI: 
PATIENT WAS APPARENTLY ALRIGHT 1 DAY BACK AND THEN WENT TO FIELD AFTER CONSUMPTION OF ALCOHOL. SINCE THEN HE WAS DROWSY AND WAS TAKEN TO RAMANNAPET GOVT HOSPITAL AND WAS TREATED THERE FOR HIS GRBS-79mg/dl. HE WAS STILL DROWSY AND BROUGHT TO CASUALITY WITH ALTERED SENSORIUM AT 8:00PM ON 27/11/2022.

PAST HISTORY: 
HE IS A K/C/O DM 2 SINCE 2 YEARS AND ON MEDICATION T. METFORMIN 500 MG, T. GLIMIPERIDE 1MG.
HE IS A K/C/O HTN SINCE 2 YEARS AND ON MEDICATION TELMA 4OMG.
HE HAD H/O SEIZURES 2 YEARS AGO.
PERSONAL HISTORY :
Diet - Mixed
Appetite-Normal
Sleep-Adequate
Bowel and Bladder movements-Regular
Addictions- He consumes alcohol 90ml/day since 40 years. 

ON  EXAMINATION: 
PATIENT IS CONSCIOUS, INCOHERENT. 
Moderately built and moderately nourished.
No pallor, icterus, cyanosis, clubbing, lymphadenopathy, edema.

VITALS:
BP-140/80MMHG
PR-76BPM
RR- 18CPM.
GRBS-162MG/DL.
SYSTEMIC EXAMINATION :
CVS-S1, S2 +
RS-BAE+
CNS-NAD
P/A - SOFT, NON TENDER. 

INVESTIGATIONS :
USG ABDOMEN:
ECG
Hemogram(on 28/11/2022) 


DIAGNOSIS:
ALTERED SENSORIUM . 
? HYPOGLYCEMIC WITH K/C/O  HTN/DM/SEIZURES
PAROXYSMAL ATRIAL FIBRILLATION. 
TREATMENT:
1). THIAMINE 800MG in 500ml NS. IV  @100ML/HR STAT. 
2)T.METXL 25MG PO/STAT
3) INJ. THIAMINE 200MG IN 100ML NS IV/BD.
4)LEVIPIL 500MG PO/BD . 
5) TAB. DOLO 650MG TID. 
6) INJ. NEOMOL 1GM IV/SOS (IF TEMP MORE THAN 101°F.
7) BP, GRBS MONITORING 2ND HOURLY. 

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