49yr old male

A 49 YEAR OLD MALE PATIENT CAME WITH SEVERE VOMITINGS AND HIGH BLOOD SUGARS.
CASE SHEET:

Chief complaints:

A 47 year old male, driver by occupation, came to causality with chief complaints of:
- vomitings since 2:00 a.m.- 8-10 episodes
   (18-07-2022)

HISTORY OF PRESENT ILLNESS:

The patient was apparently asymptomatic 10 years back. Then he had fever, generalised weakness for which he got checked with the local practitioner and was diagnosed with type II Diabetes Mellitus and started with OHA (oral hypoglycemic agents).

A year later, he developed headacheheadache and was diagnosed with hypertension for which he used medication for an year and stopped them.

6 years back, the patient developed weakness of limbs (lower limbs weakness than that of your limbs) for which he got diagnosed with low potassium levels and treatment was given conservatively.

15 days back, the patient had symptoms of headache with blackouts. He also developed vomitings 3 to 4 episodes for which he went to a local hospital and was referred to higher centre, where he was diagnosed to have acute ischemic stroke (posterior circulation stroke).

A day back, the patient woke up in the middle of night at 2:00 a.m. and had vomitings 8 episodes, followed by dizziness, for which he went to a local hospital and was found to have high blood sugars and was referred to our hospital.

ASSOCIATED DISEASES:

The patient is a known case of type II Diabetes Mellitus for 10 years.

PAST HISTORY:

The patient is a known case of acute ischemic stroke 15 days back (left postero-inferior aspect of cerebellum and left middle cerebellar peduncle).

PERSONAL HISTORY:

Diet: Mixed
Bowel: Regular
Micturition: Normal
Appetite: Normal
Habits: Regular alcohol intake and smoking
No history of allergy, asthma, epilepsy, tuberculosis, coronary artery diseases.

FAMILY HISTORY:

Known history of diabetes in parents of the patient.

DRUG HISTORY:

Tab: METFORMIN - 500mg B.D. for 10 years

GENERAL EXAMINATION:

No cyanosis
No clubbing
No pedal edema
No lymphadenopathyVITALS:

Temperature: 98.8 F

Pulse: 106 beats per minute

Respiratory rate: 20 cycles per minute

Blood pressure: 160/100 mm of Hg

SPO2: 99%

GRBS: 416mg%

SYSTEMIC EXAMINATION:

Cardiovascular system:

No thrills
Cardiac sounds: S1, SE are heard
No murumurs

Respiratory system:

No dyspnea
No wheezing
Breath sounds heard : vesicular

ABDOMEN:

Shape: scaphoid
Pain: squeezing type of pain
No palpable mass
No bruits
No free fluid
Non palpable liver
Non palpable spleen
Bowel sounds: heard

Central Nervous system:

Patient is conscious, coherent and cooperative
Speech: normal

Investigations:

Colour DopplerDoppler 2d echo:
PROVISIONAL DIAGNOSIS:
DIABETIC KETOACIDOSIS
Medication given:
Unfortunately, the patient expired , beside treatment, due to cardiogenic shock secondary to paroxysmal supraventricular tachycardia.

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