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

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