JANUARY 29, 2024
THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HER SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
48F OPD PATIENT WITH DIABETES MELLITUS II SINCE 10YRS AND NEUROPATHY SINCE 15 DAYS.
A 48 year old female came to the OPD for regular check up.
History of Presenting Illness:
A 48 yr old female came to OP for regular check up and is a K/C/O Diabetes Mellitus since 10 yrs and also complains of pins and needles sensation in B/L foot since 15 days which is aggravated on walking and relieved on resting.
Past History:
K/C/O Diabetes Mellitus since 10yrs and is on Glimi-M1
H/O right leg cellulitis 1 month back.
H/O Hysterectomy 30yrs ago.
N/K/C/O HTN, Asthma, Tuberculosis, Epilepsy, CAD, CVD
Family History: Not significant
Personal History:
Diet - Mixed
Appetite - Normal
Bowel and Bladder Movements - Normal
Sleep - Inadequate
Addictions - Nil
VITALS -
Temperature - Afebrile
Pulse rate - 86 beats/min
Respiratory Rate - 18 cycles/min
Blood Pressure - 130/80mmHg
GENERAL EXAMINATION
Patient's consent was taken.
Patient was examined in a well lit room.
She was conscious, coherent, co-operative.
No Pallor
No Icterus.
No Cyanosis.
No Clubbing.
No Lymphadenopathy
Pitting type of pedal edema is present.
Daily activity charting:
14/12/23 to 3/1/24:
Tab. Glimi- M1 PO/OD
1——X——X
14/12/23
16/12/23:
17/12/23:
18/12/23:
20/12/23:
20/12/23:
22/12/23:
24/12/23:
28/12/23:
29/12/23:
[04/01/24, 1:54:29 PM] PPM 3:
[04/01/24, 4:09:26 PM] PPM 1 : Creatinine 0.9
Deleting the previous image as patient identifiers are visible
[05/01/24, 10:40:17 AM] PPM 3: Breakfast
Lunch
Dinner
[09/01/24, 8:28:00 AM] PPM 1: Weekly 10 readings of home BP in 24 hours?
Weekly home Fbs, ppbs after every meal (4 values, one fasting, 3 two hour post meal, assuming three meals)
[09/01/24, 9:31:59 AM] PPM 3: Ok sir
[09/01/24, 9:55:12 AM] PPM 3: Patient complaining of pins and needle sensations in her legs
[09/01/24, 11:21:56 AM] PPM 3: Image omitted
[09/01/24, 11:23:11 AM] PPM 1: 10 readings expected today spaced out at random intervals over 24 hours
[09/01/24, 11:25:42 AM] PPM 3: Ok sir
[09/01/24, 11:37:50 AM] PPM 3:
[09-01-2024 11.38] PPM 3: Post breakfast GRBS 398mg/dl
[09/01/24, 11:44:07 AM] PPM 1 : What tablet did she take before this?!! 🧐😳
[09/01/24, 11:48:00 AM] PPM 3: Sir she took Tab Glimi 1.5 mg + Tab Metformin 500 mg before breakfast
[09/01/24, 11:53:30 AM] PPM 1: She needs to increase the dose of Glimeperide to 2 mg asap from tomorrow
What about her fasting today?
[09/01/24, 12:00:30 PM] PPM 3: Ok sir. She’ll get it done tomorrow morning.
[09/01/24, 12:10:28 PM] PPM 1: Ask her to report all her two hour post meal sugars today
[09/01/24, 12:13:40 PM] PPM 3: Ok sir
[09/01/24, 12:22:33 PM] PPM 3: 157/99, PR 84
[09/01/2024 13.34] PPM 3: 139/90, 83
Dinner
[10/01/24, 11:33:38 AM] PPM 3:
[10/01/24, 11:35:37 AM] PPM 3: 145/108, 83
[10/01/24, 11:51:42 AM] PPM 3: FASTING GRBS: 264mg/dl
[10/01/24, 2:25:56 PM] PPM 1: Our hospital lab?
[10/01/24, 2:29:08 PM] PPM 3: Outside lab sir
[10/01/24, 2:31:05 PM] PPM 1: Was the method used hplc or latex?
What method does our lab use?
[10/01/24, 2:35:40 PM] PPM 3: Sir our lab uses latex method
[10/01/24, 2:37:42 PM] PPM 1: And their lab?
[10/01/24, 2:38:44 PM] PPM 1: What are the comparative effectiveness results reported in terms of sensitivity specificity of both?
Lunch
[10/01/24, 4:25:16 PM] PPM 3: Post lunch GRBS 356mg/dl
[10/01/24, 4:33:34 PM] PPM 1: The tablets in the image don't reduce pins and needle sensations
She needs to be put on Tablet Pregabalin 75 mg one hour before dinner regularly for that
[10/01/24, 4:54:46 PM] PPM 3:
Tab. Glimi 2.5 mg po/od before breakfast
Tab. Glimi 0.5mg po/od after dinner
Tab. Pregabalin 75mg po/od 1hr before dinner
Tab. Metformin 500mg po/bd after breakfast and after dinner
[10/01/24, 4:58:44 PM] PPM 1: Also after lunch
[10/01/24, 5:00:24 PM] PPM 3: Ok sir
[10/01/24, 8:13:06 PM] PPM 3: 268mg/dl
[10/01/24, 8:13:06 PM] PPM 3: Pre dinner GRBS
[10/01/24, 8:14:02 PM] PPM 1: Let her take Glimeperide 0.5mg
[10/01/24, 8:21:07 PM] PPM 3: Ok sir
[10/01/24, 8:52:14 PM] PPM 3: Dinner
[11/01/24, 8:44:13 AM] PPM 3: Fasting GRBS 242mg/dl
Breakfast:
[11-01-2024 13.35] PPM 3: BP 146/91, PR 89, Post breakfast GRBS: 365mg/dl, Pre lunch GRBS: 277mg/dl
Lunch:
Dinner:
[12/01/24, 7:48:36 AM] PPM 3: Fasting GRBS 285mg/dl
Breakfast:
[12-01-2024 13.45] PPM 3: Post breakfast GRBS: 234mg/dl, Pre-lunch GRBS: 313mg/dl
Lunch:
[12-01-2024 15.45] PPM 3: Post lunch GRBS: 340mg/dl
[12-01-2024 20.15] PPM 3: Pre dinner GRBS: 302mg/dl
Dinner:
[12-01-2024 22.15] PPM 3: Post dinner GRBS: 267mg/dl
[13/01/24, 9:19:34 AM] PPM 3: Fasting GRBS: 307mg/dl
Breakfast:
[13-01-2024 11.30] PPM 3: Post breakfast GRBS: 373mg/dl
[13-01-2024 14.00] PPM 3: Pre lunch GRBS: 273mg/dl
Lunch:
[14-01-2024 20.55] PPM 3: Pre dinner GRBS 300mg/dl
Tab. Glimi 3mg po/od before breakfast
Tab. Glimi 1.5mg po/od after dinner
Tab. Pregabalin 75mg po/od 1hr before dinner
Tab. Metformin 500mg po/bd after breakfast, after lunch and after dinner
[14-01-2024 22.55] PPM 3: Post dinner GRBS: 354mg/dl
[15/01/24, 12:08:51 AM] PPM 3:
[15-01-2024 15.25] PPM 3: Post lunch GRBS: 229mg/dl
Lunch:
[16-01-2024 11.51] PPM 3: Fasting GRBS 280mg/dl
Breakfast:
[16-01-2025 20.13] PPM 3: Pre dinner GRBS: 267mg/dl
[17/01/24, 1:11:01 PM] PPM 3: Pre lunch GRBS 261mg/dl
Lunch:
Post lunch GRBS: 281/g/dl
[18/01/24, 7:51:19 PM] PPM 1: Try to explain to her that the two hour post meal can tell us best about the effect of the drug rather than just a pre meal sugar as the timing of the pre meal is likely to change everytime with whenever the patient wants to have the meal whereas two hour post meal will always be two hour post meal
[18/01/24, 8:06:11 PM] PPM 3: Ok Sir
[18/01/24, 8:06:21 PM] PPM 3:
Tab. Glimi 3.5 mg po/od before breakfast
Tab. Glimi 2.5mg po/od after dinner
Tab. Pregabalin 75mg po/od 1hr before dinner
Tab. Metformin 500mg po/bd after breakfast, after lunch and after dinner
Pre dinner GRBS: 224mg/dl
Dinner:
Post Dinner GRBS: 288mg/dl
[19/01/24, 8:26:39 AM] PPM 3:
Tab. Glimi 3.5 mg po/od before breakfast
Tab. Glimi 2.5mg po/od after dinner
Tab. Pregabalin 75mg po/od 1hr before dinner
Tab. Metformin 500mg po/bd after breakfast, after lunch and after dinner
Fasting GRBS: 260mg/dl
Breakfast:
Pre lunch GRBS: 225mg/dl
Lunch:
Post lunch GRBS: 228mg/dl
Pre dinner GRBS: 287mg/dl
Dinner:
[20/01/24, 8:51:09 AM] PPM 3: Fasting GRBS: 268mg/dl
Tab. Glimi 3.5 mg po/od before breakfast
Tab. Glimi 2.5mg po/od after dinner
Tab. Pregabalin 75mg po/od 1hr before dinner
Tab. Metformin 500mg po/bd after breakfast, after lunch and after dinner
Breakfast:
Post Breakfast GRBS: 271mg/dl
Pre lunch GRBS: 205mg/dl
Lunch:
Post Lunch GRBS: 215mg/dl
Dinner:
Post dinner GRBS: 247mg/dl
[20/01/24, 11:43:40 PM] PPM 1: 👍
[21/01/24, 1:10:04 PM] PPM 3: Fasting GRBS: 241mg/dl
Breakfast:
Lunch:
Post Lunch GRBS: 192mg/dl
Dinner:
[22-01-2024 09.21] PPM 3: Fasting GRBS: 260mg/dl
Tab. Glimi 4 mg po/od before breakfast
Tab. Glimi 3 mg po/od after dinner
Tab. Pregabalin 75mg po/od 1hr before dinner
Tab. Metformin 500mg po/bd after breakfast, after lunch and after dinner
Lunch:
Post lunch GRBS: 188mg/dl
[23/01/24, 11:11:26 AM] PPM 3: 212mg/dl
Tab. Glimi 4 mg po/od before breakfast
Tab. Glimi 3 mg po/od after dinner
Tab. Pregabalin 75mg po/od 1hr before dinner
Tab. Metformin 500mg po/bd after breakfast, after lunch and after dinner
Breakfast:
Tab. Glimi 4 mg po/od before breakfast
Tab. Glimi 3 mg po/od before dinner
Tab. Pregabalin 75mg po/od 1hr before dinner
Tab. Metformin 500mg po/bd after breakfast, after lunch and after dinner
Breakfast:
Lunch:
Post Lunch GRBS: 251mg/dl
25/01/24:
Tab. Glimi 4 mg po/od before breakfast
Tab. Glimi 3 mg po/od before dinner
Tab. Pregabalin 75mg po/od 1hr before dinner
Tab. Metformin 500mg po/bd after breakfast, after lunch and after dinner
Fasting GRBS: 227mg/dl
Breakfast:
Lunch:
Post Lunch GRBS: 306mg/dl
Dinner:
Post dinner GRBS: 201mg/dl
[26/01/24, 3:01:31 AM] PPM 3: Fasting GRBS 228mg/dl
Tab. Glimi 4 mg po/od before breakfast
Tab. Glimi 3 mg po/od before dinner
Tab. Pregabalin 75mg po/od 1hr before dinner
Tab. Metformin 500mg po/bd after breakfast, after lunch and after dinner
Breakfast:
Lunch:
Post lunch GRBS: 298mg/dl
Dinner:
Post Dinner GRBS: 278mg/dl
[27/01/24, 12:08:26 AM] PPM 3: Fasting GRBS: 242mg/dl
Breakfast:
Dinner:
Post dinner GRBS: 193mg/dl
[28/01/24, 11:23:33 AM] PPM 3: Fasting GRBS 177mg/dl
Tab. Glimi 4 mg po/od before breakfast
Tab. Glimi 3.5 mg po/od before dinner
Tab. Metformin 500mg po/bd after breakfast, after lunch and after dinner
Lunch:
Post lunch GRBS: 228mg/dl
Dinner:
Post dinner GRBS: 184mg/dl
[29/01/24, 2:51:48 AM] PPM 3:
Tab. Glimi 4 mg po/od before breakfast
Tab. Glimi 3.5 mg po/od before dinner
Tab. Metformin 500mg po/bd after breakfast, after lunch and after dinner
[29/01/24, 8:26:43 AM] PPM 1 : How did it come down to ideal levels of control all of a sudden with current maximal doses of Glimeperide 4 mg before breakfast and 3.5mg before dinner?
How much metformin is she taking and when?
[29/01/24, 1:07:21 PM] PPM 3: Sir might be she is restricting her diet may be that’s why her post meal GRBS is coming down.
[29/01/24, 1:10:12 PM] PPM 3: Sir also here she only had a glass of milk in the dinner hence the post meal GRBS value 193 and also the next day fasting GRBS was 177
[30-01-2024 07.26] PPM 3: Fasting GRBS: 241mg/dl
Breakfast:
Lunch:
Post lunch GRBS: 266mg/dl
Dinner:
Post dinner GRBS: 158mg/dl
Learning point:
P(Population):
A total of 154 samples from patients with diabetes type 2 with HbA1c concentration covering the whole clinical range were analyzed by four commercially methods
I (Intervention):
A total of 154 samples from diabetic patients with HbA1c concentration covering the whole clinical range, were obtained through venipuncture into sterile tubes containing the EDTA K2 and tested with 4 assays ( 1.Ion exchange HPLC method , 2.Immunoassay , 3.Boronate affinity chromatography , 4.Ion exchange chromatography )within 2 days
C ( Comparison):
HbA1c measurement was performed concurrently in all cases by four commercially available assays:
1.D-10 Hb A1c (Bio-Rad Laboratories, Hercules, CA), Ion exchange HPLC method
2.Cobas Integra 400 (Roche Diagnostics, Mannheim, Germany), Immunoassay
3.NycoCard Reader II, (Axis-Shield, Oslo, Norway), Boronate affinity chromatography
4.DS5, (Drew Scientific, Le Rheu, France), Ion exchange chromatography
O ( Outcome) :
Total precision (in term of CV%) were less than 1.6 %, 1.0 %, 3.1 % and 3.3 % for D10, cobas integra 400, Nycocard reader II and DS5 respectively. The mean ± SD value of HbA1c was significantly higher when measured by D10 (7.59 % ± 1.43 %) than when estimated with the Nycocard reader II (6.87 % ± 1.17 %, r: 0.937, P < 0.05) and DS5 (6.69 ± 1.47 %, r: 0945, P < 0.05) and almost same compared to cobas integra 400 (7.66 ± 1.45, r: 0.944, P: 0.06).
49F DM WITH UNCONTROLLED SUGARS
APRIL 19, 2024
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:-
COLOUR Pale yellow
APPEARANCE Clear
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
S.typhi 'O' Antibodies1:20S.
typhi 'H' Antibodies1:40S.
PARATYPHI 'AH' ANTIBODY
No Agglutination seen
S.PARATYPHI 'BH' ANTIBODYNo Agglutination seen
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
Complains of pedal edema
Was admitted in the ward with shortness of breath a few months back.
[18-06-2025 12:18] PPM 6: Is she doing any physical activity sir?
[18-06-2025 12:19] PPM 1: Complains of low backache since June 2024. Examining her back
[18-06-2025 12:20] PPM 6: Oh okay sir, how is the bed she is sleeping on and could it be osteoporosis?
[18-06-2025 12:21] PPM 6: That couldn't be caught on Xray
we might need to do DEXA scan but it's costly
[18-06-2025 12:22] PPM 6: Are her ovaries okay?
[18-06-2025 12:24] PPM 1: Examination of spine normal. No osteoporotic fracture
[18-06-2025 12:24] PPM 6: Examination method
[18-06-2025 12:25] PPM 6: Maybe it's not a fracture yet
She might be losing minerals that can't be caught with obvious examinations.
[18-06-2025 12:25] PPM 1: Is this case reporter from your batch? 👇
[18-06-2025 12:25] PPM 6: No sir she is my junior
[18-06-2025 12:26] PPM 6: I'm 2023 graduate
[18-06-2025 12:26] PPM 1: Yes but in standard examination methods that wouldn't be thought of as osteoporosis
[18-06-2025 12:26] PPM 1: Because of her work at that time we are remembering her even today!
[18-06-2025 12:27] PPM 6: Ohh😅 she did really well i just roughly went through her blog
[18-06-2025 12:29] PPM 1: @CR we'll need to update this case report.
This patient couldn't follow up in her PaJR well
[18-06-2025 12:31] PPM 1: Currently on insulin since 1 year.
Appears to have gained weight, Pedal edema likely to be heart failure although no shortness of breath but she does have intermittent low back ache for which she needs to rest and recuperate
[18-06-2025 12:32] PPM 1: We'll get her chest X-ray, ecg, echocardiography and serum albumin and serum creatinine
[18-06-2025 12:34] PPM 6: Is she drinking alcohol and consuming any other addictives at that specific time that could cause truncal obesity..
[18-06-2025 12:48] PPM 1: No. It's purely diet and exercise which is responsible
[18-06-2025 12:56] PPM 1: @CR this will be a useful addition to the updated case report 👇
Age/Gender: 50 Years/Female
Address:
Discharge Type: Relieved
Admission Date: 22/01/2025 01:09 PM
Name of Treating Faculty
(AP)
(PGY1)
(PGY1)
Diagnosis
PEDAL EDEMA SECONDARY TO 1) HEART FAILURE WITH PEF (EF-56%) 2)? DRUGS, IRON
DEFIECIENCY ANEMIA
K/C/O HTN SINCE 1 YEAR
K/C/O DM SINCE 9 YEARS
Case History and Clinical Findings
CHEIF COMPLAINTSPEDAL
EDEMA SINCE 20DAYS
HOPIPATIENT
WAS APPARANTLY ALRIGHT BEFORE 20 DAYS THEN DEVELOPED PEDAL EDEMA,
PITTING TYPE UPTO THIGH, INSIDIOUS IN ONSET GRADUALLY PROGRESSIVE
AGRRAVATED ON PROLONGED SITTING AND NO RELIEVING FACTORS.
C/O HAND SWELLING SINCE 2 DAYS
NO H/O COLD, COUGH, ALLERGIES, CHEST PAIN, PALPITATIONS, SWEATING, SOB,
DECREASED URINE OUTPUT, CONSTIPATION, ABDOMINAL PAIN, VOMITINGS, DIARRHEA
NO C/O POLYURIA, POLYDIPSIA, POLYPHAGIA, FACIAL PUFFINESS
PAST HISTORYK/
C/O HTN SINCE 1 YEAR AND ON TAB AMLO-AT 5/50 MG PO/OD
K/C/O DM-II SINCE 9 YEARS ON INSULIN HAI S.C /TID 24U-16U-24U
Page-2
KIMS HOSPITALS
INJ IVPH S.C BD22U-22U
N/K/C/O HTN, TB, EPILEPSY, ASTHMA, CVA, CAD
H/O HYSTERECTOMY 10 YEARS BACK
PERSONAL HISTORY
DIET-MIXED
SLEEP-ADEQUATE
APPETITE- NORMAL
BOWEL MOVEMENTS- CONSTIPATION SINCE 3 DAYS
MICTURITION- BURNING +
NO ADDICTIONS
GENERAL EXAMINATION
PT IS C/C/C
TEMP.AFEBRILE
PR 86 BPM
BP 120/80MMHG
RR 16/MIN
SPO2 98%
GRBS 254 MG/DL
SYSTEMIC EXAMINATION:
CVS: S1 S2 HEARD, NO MURMURS
RS: BAE +,NVBS
P/A: SOFT, NT, NO ORAGANOMEGALY
CNS NFND
Investigation
Hemogram: HB:10 gm/dl; TLC -10500 cells/cu.mm; N/L/E/M/B-63/27/3/7; PCV-31.1; MCV 60.3 PLT
2.78 L/cumm
COMPLETE URINE EXAMINATION (CUE) 22-01-2025 02:59:PM COLOUR Pale yellow APPEARANCE Clear REACTION Acidic SP. GRAVITY 1.010ALBUMIN +++SUGAR +BILE
SALTS Nil BILE PIGMENTS Nil PUS CELLS 5-6EPITHELIAL CELLS 3-4RED BLOOD CELLS
Nil CRYSTALS Nil CASTS Nil AMORPHOUS DEPOSITS Absent OTHERS Nil
Page-3
KIMS HOSPITALS
LIVER FUNCTION TEST (LFT) 22-01-2025 02:59:PM Total Bilurubin 0.84 mg/dl 1-0 mg/dl Direct
Bilurubin 0.17 mg/dl 0.2-0.0 mg/dl SGOT(AST) 14 IU/L 31-0 IU/L SGPT(ALT) 12 IU/L 34-0
IU/L ALKALINE PHOSPHATASE 163 IU/L 98-42 IU/L TOTAL PROTEINS 6.7 gm/dl 8.3-6.4
gm/dl ALBUMIN 3.77 gm/dl 5.2-3.5 gm/dl A/G RATIO 1.29
RFT 22-01-2025 02:59:PM UREA 25 mg/dl 42-12 mg/dl CREATININE 1.1 mg/dl 1.1-0.6 mg/dl URIC
ACID 3.6 mmol/L 6-2.6 mmol/LCALCIUM 10.0 mg/dl 10.2-8.6 mg/dl PHOSPHOROUS 2.7 mg/dl 4.5-2.5 mg/dl SODIUM 141 mmol/L 145-136 mmol/L POTASSIUM 4.0 mmol/L. 5.1-3.5 mmol/L CHLORIDE 104 mmol/L 98-107 mmol/L
HBA1C- 6.75%
SERUM URIC ACID -3.6MG%
RBS- 224G/DL
FBS- 180MG/DL
POST LUNCH BLOOD SUGAR 22-01-2025 03:00:PM 245 mg/dl 140-0 mg/dL
HBsAg-RAPID 22-01-2025 02:59:PM Negative
Anti HCV Antibodies - RAPID 22-01-2025 03:01:PM Non Reactive HIV RAPID - NON REACTIVE
THYROID PROFILE:
T3- 1.13NG/ML
T4-11.26 MOCRO G/DL
TSH:- 1.82 MICRO LU/ML24 HE UPCR24 HOURS URINEPROTEIN1,650mg/day.<150 mg/day24
HOURS URINE CREATININE0.8g/day1-3 gm /day RATIO 2.06 URINE VOLUME 2,000ml
2D ECHO WAS DONE ON 23/01/2025
- NO RWMA MILD AR+
- MILD LVH +NO PAH
- TRIVIAL MR+/TR+; NO AS/MS
- SCLEROTIC AV; MV-AMLTHICKENED
- EF = 56% GOOD LV/RV SYSTOLIC FUNCTION
- GRADE I DIASTOLIC DYSFUNCTIONAL+
- IVC SIZE(0.6CM) COLLAPSING
- MINIMAL PE; NO LV CLOT
IVS - 1.2CM
ESD - 4.0CM
EDD - 5.6CM
DPW - 1.2CM
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KIMS HOSPITALS
Treatment Given (Enter only Generic Name)
INJ HAI SC/TID ACC TO GRBS
INJ NPH SC BD ACC TO GRBS
TAB LASIX 40 MG PO/OD
TAB PAN 40 MG PO/OD BBF
TAB OROFER-XT PO/OD
TAB TELMA 40 MG PO/OD
SYP LACTULOSE 15 ML PO/HS
Advice at Discharge
INJ HAI 24 TID U -18U-24U
INJ NPH BD 22U-22U
TAB LASIX 40 MG PO/OD X 1 MONTH
TAB PAN 40 MG PO/OD BBF X 1 WEEK
TAB OROFER-XT PO/ODX 3 MONTHS
TAB TELMA 40 MG PO/OD TO BE CONTINUUED
SYP LACTULOSE 15 ML PO/HS
Follow Up
REVIEW TO GM OPD AFTER 2 WEEKS/ SOS
When to Obtain Urgent Care
IN CASE OF ANY EMERGENCY IMMEDIATELY CONTACT YOUR CONSULTANT DOCTOR OR ATTEND EMERGENCY DEPARTMENT.
Preventive Care
AVOID SELF MEDICATION WITHOUT DOCTORS ADVICE, DONOT MISS MEDICATIONS. In case of Emergency or to speak to your treating FACULTY or For Appointments, Please Contact:
08682279999 For Treatment Enquiries Patient/Attendent Declaration: - The medicines prescribed
and the advice regarding preventive aspects of care, when and how to obtain urgent care have been
explained to me in my own language
SIGNATURE OF PATIENT /ATTENDER
SIGNATURE OF PG/INTERNEE
SIGNATURE OF ADMINISTRATOR
SIGNATURE OF FACULTY
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KIMS HOSPITAL
Discharge Date
Date:
Ward: FMW
Unit:III
