63yr old female patient with hypoglycaemia

 This is an online E log book 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 series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box 

chief complaints:

65 year old female patient non diabetic non hypertensive who is a Telugu tutor at home and was able to do all her house hold works on her own till 2006 then from 2006 she was getting water from step well then she got her hipand knee pains from 2008 where they took to hospital they suggested for surgery but Attendors neglected it because of financial issues then from that time patient was slowly walking from 1 year she started walking with the support(wall) and do her own works then from few days she is walking with walker  . Patient had odynophagia since 4 days then she did not take food and on the day of admission she got up in the mrng and was oriented to place time and person then after some time she was not oriented to person since afternoon then they brought patient to the hospital with complaints of

Altered behaviour since1 hr

Difficulty in swallowing since 4 days 

Past history : N/K/C/O DM ,HTN, CAD ,Asthma, TB ,seizures 

O/E : 

No

Pallor, icterus, cyanosis,clubbing,lymphadenopathy,Edema 

pt is c/c/c 

Afebrile

PR: 98bpm

BP:110/70mmHg

RR: 18cpm

CVS: S1S2+

RS:BAE+

CNS:

Handedness: right handed

Consciousness: conscious

GCS: E4V5M6

Orientation: oriented to place time and person 

Memory:

Immediate: intact 

Recent: intact 

Remote:intact 

Attention: intact 

Calculation: intact 

Cranialnerves: normal

Motor system 

Attitude - lower limbs flexed at knee joint

Muscle tone:    Right.              Left
             UL        N.                    N
             LL.       N.                     N
Muscle power: 
             UL.      5/5.                   5/5
             LL        

Reflexes 
                          Right               Left 
Biceps                 2+                   2+
Triceps                 2+                  2+ 
Supinator             2+                 2+
Knee                   -                       -
Ankle                  -                       -
Platar.                Mute                Extends

Superficial reflexes and deep reflexes are present , normal

Sensory system - all sensations ( pain, touch, temperature, position, vibration sense) are normal

Diagnosis:
 Altered sensorium secondary to hypoglycaemia(recovered)
Hyponatremia

Investigations :







 


















Treatment: 
1.I.v fluids 0.9%Nacl@30ml/hr
2.GRBS 6th hrly monitoring 
3.BP 2 bd hrly monitoring 










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