A 70 year old male with altered sensorium,shortness of breath .




  A 70 year old male ,resident of ramannapet,industrial worker by occupation came to casuality with, 

C/O  Altered sensorium since morning 5am and             Shortness of breath since morning 5am.

History of presenting illness:

         Patient was apparently asymptomatic 20 years back and then he went to regular check up and got diagnosed with Diabetes Mellitus ,he was prescribed oral antihyperglycemic drugs which is continuing till now.

18 years back ,he had a H/O trauma to his little toe of left leg and he developed cellulitis to his little toe .So he went to a hospital and got his left little toe amputated and was covered with skin grafting at that place .

6 years back ,he had a H/O cellulitis to his left lower leg .So he went to a hospital and got fasciotomy in that area ,since then insulin has been started,Mixed insulin (30/70)  35U * 30U




7 months back ,he went for regular check up of diabetes ,  then he diagnosed with a kidney problem and he was prescribed with a medication of ,

           DAPAGLIFOZIN-10mg OD

H/O burning micturition since 2 days

On the day of admission ,at morning 5 am ,he woke up for micturition and went back to sleep.After that ,he was found to have involuntary hand and leg movements ,and was not responding to speech ,profusely sweating and Shortness of breath which is grade-4.

Past history:

He is a known case of diabetes mellitus type 2 from 20 years .

He tested COVID positive 20 days back

No C/O chest pain,palpitations

No H/O asthma,coronary artery disease,Epilepsy

Personal history:

Mixed diet 

Normal appetite

Sleep -adequate

Bowel and bladder- micturition 5-8 times per day and of 1 time during night

Alcohol consumption on occasions.

Family history:

His mother is a known case of diabetes mellitus at her middle age.And his son is also a known case of diabetes mellitus from 6-7 years.

Surgical history:

Implantation of intra ocular lens in both eyes 12 years back.

GENERAL EXAMINATION:

Patient is conscious,coherent and co-operative .Well built and well oriented with time ,place, person.

No pallor,icterus,cyanosis,clubbing,lymphadenopathy,

Edema-present

Vitals:BP-130/90mmHg

RR-22cpm

Temp-99.61F

PR-

SpO2-97%

GRBS: 33MG% ->>225MG%


SYSTEMIC EXAMINATION:

CVS- S1&S2 heard ,no murmurs 

RS-Normal vesicular breath sounds heard 

Per abdomen-obese,soft and non-tender



CNS-patient was drowsy initially with slurred speech

PROVISIONAL DIAGNOSIS:

Hypoglycemia secondary to oral hypoglycemic agents or insulin.

Investigations:



Treatment:Tab.CILNIDIPINE-10mg BD



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