49F DM with Uncontrolled Sugars
A 49 years old Female who is a house wife by occupation came with C/O
Fever since 15 days
Patient was apparently asymptomatic 9 years back then she started having bleeding per vagina for which she went to hospital & Diagnosed to have ? Fibroid uterus for which she went to a private hospital in hyderabad for hysterectomy as advised in local hospital. Then she had high sugars for the first time (Around 450mg/dl).So she was admitted in the hospital & hysterectomy was done after controlling the sugars with Insulin.Then she was discharged with Tab.GLIME M1 PO BD & continued the tablet for 3 years along with diabetic diet. Then she came to our OP for Follow then she was prescribed with Tab.GLIME M2 PO BD which she used for 2 years. Then she came to our OP for Follow up then she was escalated to Tab.GLIME M3 PO BD.
March 2023
She had ulcer over left great toe for which she was admitted in our hospital & got relieved.
November 2023
She had Swelling of Rt. Lower limb for which she was admitted in our hospital diagnosed as Rt.LL Cellulitis & got relieved with antibiotics & Regular dressings
April 2024
Fever which is of high grade ; Intermittent; Relieved by taking antipyretics
No H/O Cough ; Cold
No H/O Headache; Nausea ; Vomitings ; Loose Stools
No H/O Burning Micturition
Co Morbidities:
K/C/O DM Since 9 years
N/K/C/O HTN ; TB ; Asthma ; Epilepsy
Chest Xray on 18/04/24
ABG on 18/04/24 :
Investigations on 18/04/24 :
Serology : Negetive
FBS : 193 mg/dl
PPBS : 493 mg/dl
HbA1c : 7.6%
USG Abdomen on 18/04/24 :
2nd Admission :
Case History and Clinical Findings
C/O FEVER SINCE 2WEEKS
HISTORY OF PRESENT ILLNESS : PATIENT WAS APPARENTLY ASYMPTOMATIC 2 WEEKS BACK AND THEN SHE DEVELOPED FEVER 2 WEEKS A/W CHILLS AND RIGORS ANS RELIEVED IN BETWEEN BUT SINCE TODAY MORNING THE FEVER IS PRESENT ,HIGH GRADE ,CONTINOUS TYPE A/W CHILLS AND RIGORS ,HEADACHE +,NO AGGRAVATING AND RELIEVING FACTORS
NO H/O BURNING MICTURATION
NO H/O PAIN ABDOMEN , VOMMITINGS
NO H/O CHEST PAIN , PALPITATIONS
NO H/O COLD , COUGH
NO H/O PEDAL EDEMA,DRUG NON COMPLIANCE
HISTORY OF PAST ILLNESS :
K/C/O DM SINCE 9 YEARS AND ON INJ HAI/SC/TID 16U-16U-16U
INJ NPH SC /BD 14U-X-14U
K/C/O HTN SINCE 6 DAYS AND ON TAB TELMA 20MG PO/OD
N/K/C/O THYROID DISORDERS , ASTHMA , TB , EPILEPSY , CAD , CVA
MENSTRUAL HISTORY :
HYSTERECTOMY DONE 9 YEARS AGO
ON EXAMINATION
PT IS CONSCIOUS, COHERENT,COOPERATIVE
TEMP-101 F
PULSE RATE 92 BPM
BP 140/90 MMHG
GRBS -256MG/DL
CVS-S1 S2 HEARD NO MURMURS
RS- BAE PRESENT NVB
P/A-SOFT,NON TENDER
PROVISIONAL DIAGNOSIS:-
ENTERIC FEVER
DIABETES MELLITUS SINCE 9 YEARS
HYPERTENSION SINCE 1 WEEK
WITH ANEMIA-MCHC SECONDARY TO NUTRITIONAL CAUSE
Investigation
COMPLETE URINE EXAMINATION (CUE) 28-04-2024 05:16:PM:-
COLOURPaleyellow
APPEARANCEClear
REACTIONAcidic
SP.GRAVITY1.010
ALBUMIN+++
SUGAR - Nil
BILE SALTS - Nil
BILE PIGMENTS - Nil
PUS CELLS - 4-5
EPITHELIAL CELLS - 2-4
RED BLOOD CELLS - Nil
CRYSTALS - Nil
CASTS - Nil
AMORPHOUS DEPOSITS - Absent
OTHERS - Nil
RFT 28-04-2024 05:16:PM :-
UREA - 21 mg/dl42-12 mg/dl
CREATININE - 0.9 mg/dl1.1-0.6 mg/dl
URIC ACID. -2.8 mmol/L6-2.6 mmol/L
CALCIUM - 10.0 mg/dl10.2-8.6 mg/dl
PHOSPHOROUS - 2.0 mg/dl4.5-2.5 mg/dl
SODIUM -137 mmol/L145-136 mmol/L
POTASSIUM - 3.6 mmol/L.5.1-3.5 mmol/L.
CHLORIDE - 103 mmol/L98-107 mmol/L
POST LUNCH BLOOD SUGAR - 28-04-2024 05:19:PM:-237 mg/dl140-0 mg/dl
WIDAL TEST- 28- 04-202405:19:PM
S.typhi 'O' Antibodies1:20S.
typhi 'H' Antibodies1:40S.
PARATYPHI 'AH' ANTIBODY
No Agglutinationseen
S.PARATYPHI 'BH' ANTIBODYNo Agglutinationseen
HEMOGRAM:-
28/4/24 -
HB-7.7
TLC-16000
PLT-4.07
RBC-4.05
29/4/24
HB-6.3
TLC-13200
PLT-2.77
RBC-3.39
30/4/24
HB-6.1
TLC-9700
PLT-2.99
RBC-3.25
DENGUE- NEGATIVE
MALARIAL PARASITE- NEGATIVE
M.P STRIP TEST- NEGATIVE
URINE FOR KB- NEGATIVE
Treatment Given:-
INJ AUGMENTIN 1.2GM IV/BD X 5 DAYS
INJ PAN 40MG IV/OD
INJ HAI S/C TID
INJ NPH S/C BD ACC TO GRBS
T.METFORMIN 500MG PO/OD
TAB TELMA 20MG PO/OD
T.DOLO 650MG PO/SOS
INJ IRON SUCROSE 200MG IN 100ML NS IV/OD
