47F with oral hypoglycemic drug induced hypoglycemia with post renal AKI with B/L hydroureteronephrosis with cystitis with DM 2 with denovo HTN

DOA -6/2/2023 
Discharge Date
Date:11/2/23
Ward:MEDICALWARD
Unit:GM 1

Diagnosis
ORAL HYPOGLYCEMIC DRUG INDUCED HYPOGLYCEMIA
POST RENAL ACUTE KIDNEY INJURY WITH B/L HYDROURETERO NEPHROSIS WITHCYCTITIS
?PRE RENAL ACUTE KIDNEY INJURYANEMIA OF CHRONIC DISEASE
K/C/O DIABTES MELLITUS TYPE II SINCE 5 YEARSDENOVO HYPERTENSION

Case History and Clinical Findings
CHIEF COMPLAINTS:
C/O SHIVERING SINCE MORNINGC/O SWEATING SINCE MORNING
HOPI:
PATIENT WAS APPARENTLY ASYMPTOMATIC 4 MONTHS BACK THEN SHE HAD SWEATING,BREIF LOSS OF CONSCIOUSNESS AND WENT TO LOCAL HOSPITAL DIAGNOSED WITHHYPOGLYCEMIC EPISODE. SHE HAD SIMILAR TWO EPISODES IN THE MIDNIGHT 1 DAYBACK. SHE WAS BROUGHT TO OUR HOSPITAL FOR FURTHER MANAGEMENT.

PAST HISTORY:
H/O SIMILAR EPISODE IN THE PAST 4 MONTHS BACK.K/C/O DM SINCE 5 YEARS (ON GLIMI M1)
NOT A K/C/O HTN, EPILEPSY, TB, ASTHMA, THYROID.

GENERAL EXAMINATION:
PATIENT IS CONSCIOUS, COHERENT AND COOPERATIVE.
NO PALLOR, ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY.EDEMA OF FEET PRESENT.

VITALS AT ADMISSION:
TEMPERATURE: AFEBRILE
PR:112BPM
RR:24CPMBP:180/110MMHGSPO2:100%GRBS:38MG/DL

SYSTEMICEXAMINATION:
CVS: S1S2 PRESENTNO MURMURSRESPIRATORYSYSTEM:
NORAML VESICULAR BREATH SOUNDS HEARDPER ABDOMEN:
SHAPE OF ABDOMEN : OBESESOFT AND NONTENDER
CNS: NFND
VITALS AT DISCHARGE :BP:140/80MMHGPR:82BPMGRBS:90MMHG
COURSE IN THE HOSPITAL:-
47YEAR OLD FEMALE, KNOWN DIABETIC SINCE 5YEARS IS ON TAB.GLIMI M1 1/2TAB OD,WITH RECURRENT HYPOGLYCEMIC EPISODES PRESENTED TO OUR CASUALTY FORFURTHER MANAGEMTNENT. ON EVALUATION, HER METABOLLIC PROFILE SHOWED GRBS-38MG/DL. INJ. 25% DEXTROSE IV BOLUS AND WAS MAINTAINED AT INJ.25% DEXTROSE IV@10ML/HR.
ON NEXT DAY INJ. 25%DEXTROSE WAS TAPERED DOWN TO 2.5ML/HR.LATER WASCONVERTED TO PLENTY OF ORAL FLUIDS
GASTROENTEROLOGY OPINION WAS TAKEN FOR HETEROECHOIC LESION IN LIVERSEGMENT IV A AND ADVISED FOR AFP,CEA AND TRIPHASIC CT SCAN AND BIOPSYUROLOGYOPINIONWASTAKENFORB/LHYDROURETRONEPHROSISANDWASADVISED
NON CONTRAST CT-KUB.
OPTHALMOLOGY OPINION WAS TAKEN FOR HYPERTENSIVE AND DIABETIC RETINOPATHYAND NO CHANGES WERE SEEN
GYNECOLOGY OPINION WAS TAKEN FOR B/L HYDROURETRONEPHROSIS ANDTRANSVAGINAL SONOGRAPHY WAS DONE AND NO ABNORMALITY DETECTEDPATIENT IS BEING DISCHARGED IN HEMODYNAMICALLY STABLE CONDITION.

Investigation
HB-8.6-7.4-7.1-7.8GM/DL
TLC-7,900-6,600-6,400-7,000CELLS/CUMMPLT-2.52-2.47-2.27-2.18LAKHS

2D ECHO:
MILD MR+; TRIVIAL TR+; NO MRNO RWMA. NO AS/MS
GOOD LV SYSTOLIC FUNCTIONDIASTOLIC DYSFUNCTION +; NO PAH/PEREVIEW 2D ECHO: 8/2/23
NO RWMA MILD LVH+
MILD AR+; TRIVIAL TR+/MR+SCLEROTIC AV, NO AS/MSEF=58; RVSP:35MMHG
GOOD LV SYSTOLIC FUNCTIONDIASTOLIC DYSFUNCTION+, NO PAH/PEIVC SIZE (0.81CMS) COLLAPSING


USG:6/2/23RT.KIDNEY-11*5.2CM
LEFT KIDNEY- 10.8*5CM
E/O HETEROECHOIC LESION IN THE LIVER SEGMENT 4 A , LIKELY MALIGNANT ETIOLOGYB/L HYDROURETERO NEPHROSIS
RIGHT COMPLEX CYST IN KIDNEY.
INTERNAL ECHOES SEEN WITH BLADDER WALL THICKENING ?CYSTITIS CORRELATE WITHCUE.

REVIEW USG I/V/O CORTICAL THICKNESS:
IMPRESSION:
B/L MODERATE HYDROURETERONEPHROSISSIGNIFIACNT PVR

TRANSVAGINALSONOGRAPHY 11/2/23UTERUS:-6.3*2.6CM
ET-2-3MMMYOMETRIUM-NORMAL
OVARIES-NOT VISUALISEDPOUCH OF DUGLUS-NIL

AFP-1.50CEA-1.86

Treatment Given(Enter only Generic Name)
INJ 25% DEXTROSE IV @15 ML/HR (INCREASE OR DECREASE TO MAINTAIN GRBS 200-250MG/DL)
IV FLUIDS 1 NS AND 1 RL @ 125 ML/HRTAB CILNIDIPINE 10 MG PO/OD
SYP CREMAFFIN PLUS PO/H//S 10 MLWITHHOLD OHS

Advice at Discharge
TAKE PLENTY OF ORAL FLUIDS
TAB CILNIDIPINE 10 MG PO OD AT 8AM
TAB OROFER XT PO/OD AT 2PM FOR 1 MONTH
SYP CREMAFFIN PLUS PO/HS 10 ML AT 9PM BEDTIME
WITHHOLD ORALHYPOGLYCEMIC DRUGS

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