66 old male with hypoglycemia since one day ckd on glimiperide , DM 2 since 20 years , left lower limb filariasis since 35 years

Cheif complaints:
Patient was brought to casuality in altered sensorium since 4pm yesterday

HOPI: patient was apparently asymptomatic before 4pm yesterday then he developed altered sensorium since with involuntary movements of both upper limbs, shevering, cold intolerance sweating, 
patient also complained of chest pain at 7pm, profuse sweating present, shevering present,
H/o fever since 2 days, high grade associated with chills and rigors not relieved by medication
No vomitings amd loose stools

Past h/o 
K/c/o left lower limb filiriasis
K/c/o dm 2 since 6 years
using glimeperide 2 mg , metformin 500mg
K/c/o HTN since 2 months
K/c/o ckd stage 3A
K/c/of HBSAG since 2 months
Acute infract in right frontal lobe
K/c/o left hemisparisis since one month 
Vitals:
Bp : 140/90mmhg
Pr : 140 bpm
Grbs: 35 mg/dl at admission given 25D later it is 180 mg/dl
Temp : 103 f
Cvs :. S1 s2 heard no murmurs
Rs : b/l AE present
P/A : soft. Non tender
Investigations
28/8/23
30/8/23
1/9/23
Soap notes
Admission : 27/8/23
Dr.susmitha sr
Dr.navya pgy1
Dr.nishitha PGY2
S:
Patient is in altered sensorium since 2 days

O:
Vitals:
Patient is oriented to time , person but not to place
Bp : 140/70mmhg
Pr : 110bpm
Rr : 24 cpm
Grbs: 189 at 8am
Temp : 98.7 f
Cvs :. S1 s2 heard no murmurs
Rs : b/l AE present
P/A : soft. Non tender

A: 
Altered sensorium secondary to hypoglycemia secondary to OHA's
Pyrexia under evaluation
K/c/o cva since 2 months
K/c/o DM type 2 since 2 years
HTN AND CKD and cks since 2months

P:
Inj.neomol 1gm iv
Inj.25percent dextrose 40 ml/hr increase or decrease acc to grbs
T.tenofovir 300 mg po od
T. Amlong 5mg rt/od
T.ecosprin av gold 75/75/20 Rt/HS

T.PCM 650 mg RT/TID

SYP.potchlor 15 ml RT/TID

GRBS AND BP amd temperature monitering


Admission : 27/8/23
Dr.susmitha sr
Dr.navya pgy1
Dr.nishitha PGY2

S:
Patient is conscious coherent and cooperative but he unable to remember us today, we spoke to him yesterday for half an hour

O:
Vitals:
Patient is oriented to time , person but not to place
Bp : 130/90mmhg
Pr : 102bpm
Rr : 24 cpm
Grbs: 305 mg/dl 6 units hai given
Temp : 98.7 f
Cvs :. S1 s2 heard no murmurs
Rs : b/l AE present
P/A : soft. Non tender

A: 
Altered sensorium secondary to hypoglycemia secondary to OHA's ( resolved)
Pyrexia resolved
K/c/o cva since 2 months
K/c/o DM type 2 since 2 years
HTN AND CKD and ckd since 2months

P:
Inj.neomol 1gm iv
T.tenofovir 300 mg po od
T. Amlong 5mg rt/od
T.ecosprin av gold 75/75/20 Rt/HS

GRBS AND BP amd temperature monitering

Admission : 27/8/23
Dr.susmitha sr
Dr.navya pgy1
Dr.nishitha PGY2

S:
Patient is conscious coherent and cooperative and drowsy

O:
Vitals:
Patient is oriented to time , place and person
Bp : 110/60mmhg
Pr : 112bpm
Rr : 22 cpm
Grbs: 248 mg/dl 8 units hai given
Temp : 98.7 f
Cvs :. S1 s2 heard no murmurs
Rs : b/l AE present
P/A : soft. Non tender
 
Cns tone RT LT
             Ul. N. N
             Ll. N.        
 
Power RT LT

            UL. 5/5 5/5
            LL. 5/5
Reflex:
            B +3 +3    
            T +3 +3
             S +3 +3
             K +3       
             A +3
             P F F
A: 
Altered sensorium secondary to hypoglycemia secondary to OHA's ( resolved)
K/c/o cva since 2 months
K/c/o DM type 2 since 2 years
HTN AND CKD and ckd since 2months

P:
Inj.hai sc/tid acc yo grbs 
T.tenofovir 300 mg po od
T. Amlong 5mg rt/od
T.ecosprin av gold 75/75/20 Rt/HS
T.cinod 10mg po bd

GRBS AND BP amd temperature monitering

His blood sugar levels during the hospital stay

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