10-10-2024
This is an online E Log book to discuss our patient's de-identified health data shared after taking his 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 patients clinical problems with collective current best evidence based inputs.
The patient is a 50yr old male with Diabetes since 14yrs and had brain neurosurgery one month back. He had brain stroke and his right side of the body is paralysed.
The patient 50M diabetic was admitted thrice.
First in March 2023
Second in June 2023
Third in September 2023.
Right hemiparesis with right medullary Infarction Wallenbergs. Acute coma due to left MCA Vasculopathy with raised ICT treated here neurosurgically with decompression craniectomy
PPM 2 - Just wondering is it respecting the MCA territory on this one?
PPM 1 - This is the post-operative CT head and till we can locate the pre-operative image it's difficult to confirm @PPM 3 Would you have that in your unit group?
PPM 3 -
PPM 1 - Yes it's a hemorrhage primarily with intrventricular extension.
PPM 2 - Hopefully not a GBM or a Brain abscess.
09-10-2024
PPM 1 - That was a month back and there was no such issues found before and after the craniectomy.
PPM 2 - 👍
12-10-24
PPM 1 - I suspect there is a lot of sugar in the powder you are feeding him through the rules tube which is also causing reflux leading to his cough.
PA - The Fasting sugar value is 339. The patient was given 14U.
Where are you injecting the patient? After injection is any water oozing from that particular point?
PA - 2 hrs after food the sugar value is 110. There is no oozing of water. Should the patient be given Insulin?
PPM 2 - Please continue Insulin. Please share the pics of the protein powder you are feeding the patient. Both sides of the container pics.
PPM 1 - Sugar is 0 👏. In the above description.
PPM 2 - What would those carbs be though?
PA - OK Sir today the madam advised this powder.
PPM 1 - The photo is blurred and unreadable. Those carbs are soluble fiber.
PPM 2 - Wouldn't be too far fetched to think Indian brands would lie through their teeth and contaminate their way through the market. Even galactose, fructose and glucose ( mind you sucrose is a polymer of glucose+fructose) and even maltose are all possible!
PPM 1 - 👍
PPM 2 - Very sketchy website is all I can see here- https://www.signutra.com/indexphp
PA - Should we give the patient the powder with milk or not Sir?
PPM 1 - Can give the powder with milk. How many times is it given? He will need to be given actrapid Insulin everything you give the rules tube feeds.
PA - OK Sir , we gave morning and evening and now madam is asking to give only once daily.
PPM 1 - In one single day of 24hrs, how many times do you give rules tube feeds to the patient?
PA - We give morning milk at 8 am, Ragi at 12pm, and after 2pm sorghum malt or rice. In the night we give milk. Sir, madam advised us to give milk in the morning, Ragi malt in the afternoon and sorghum malt in the night.
13-10-2024
PPM 1 - Madam has been added.
PA - Fasting sugar is 226. Actrapid 14U and NPH 8U is given Sir.
What was the dose of NPH and actrapid taken yesterday night?
PA - The patient got cough in the night at 1.30am, then was given Budecort nebulization.
PPM 1 - 👍
Please inform the blood sugars 2 hrs after this.
PA - OK Sir.
PPM 1 - Did he have a better night in terms of cough after the Budecort nebulization yesterday?
PA - He slept. Early morning at 4am when he got cough again I administered Levolien nebulization. Now he is okay.
PPM 1 - These symptoms of cough increasingly with lying down are very much suggestive of reflux. Please make him sit up in a chair for one to two hours after his meals. Also his bed headend can be elevated by 15 degree as shown in the pic here. https://images.app.goo.gl/BGEWqbyYMgpb4EEz8.
PA - NPH 8U and actrapid 12U given to the patient. After 1hr the sugar level was 185.
PPM 1 - 👍
PA - Sir checked GRBS at 11.39pm. It is 75.
PA - At 7pm gave Insulin. It was 295.
PA - Actrapid 14U, NPH 8U. Daily dose.
PPM 2 - Okay. Is the patient having any symptoms?
Actrapid 14U and NPH 8U, what time exactly did you administer?
PA - 7.40pm. What symptoms Sir?
PPM 2 - Please observe the patient for sometime. If possible in 2 hrs if the patient feels uneasy please inform.
PA - He is sleeping, no problem.
PPM 2 - OK after 2 hrs please check.
PA - Can we give him some milk?
PPM 2 - Don't give anything now. Will see after 2hrs.
PA - OK Sir patient is cool.
PPM 2 - Sweating?
PA - No, normal.
PPM 2 - OK from tomorrow NPH 6U only in the night.
PA - OK Sir
14-10-2024
PA - Sir the sugar level is 78. Is there any problem?
PA - I am afraid the sugar is very low. Should I give him some milk?
PPM 2 - Nothing to worry. Let the patient have a good sleep. Don't disturb him.
PA - The patient is having a good sleep today. He took bath today.
PPM 2 - 👍
PA - The patient's BP is 100/80, temp- 96.7, SPO2 95, pulse 96, and urine volume is also good 300ml.
PPM 2 - 👍
Please remember that the patient should be given actrapid 10U in the night.
Actrapid 14-8-10, NPH- 8U and 6U.
PA - Yesterday madam told Sir.
PPM 2 - 👍 Okay.
PA - It is 68 Sir.
PA - OK Sir.
BP 100/70
PR - 112
SPO2- 92
Temperature- 96.7
Gave him milk. When to check sugar levels Sir?
PPM 2 - How much milk did you give him?
PA - 20ml water and 60ml milk. After that gave him 20ml water. Madam advised that If feeding is done from mouth, his
intake should be more.
Fasting sugar at 7am is 180. 297 at 8.30 am. Same Insulin dose. Given milk.
PA - 74 at 2pm. No Insulin Sir. Given rice.
PPM 1 - For now to make it simple as a starting point , give him 8U actrapid before each meal and 8U NPH before breakfast and dinner from today. Please share the sugar values two hours after every meal and we shall advice accordingly.
15-10-2024
PA - Fasting sugar is 271. Same dose Insulin.
Sugar value At 4pm
PA - What Sir?
PPM 2 - The sugar levels are high.
PA - Sir the patient is having constipation problem today. Will he have any gastric problem? Should we give him a syrup prescribed earlier for constipation?
PA - The sugar value is 185, 2 hrs after food.
Sugar value at 2 am is 214
18-10-2024
PA - Today Fasting sugar is 198.
PPM 1 - Walking will help him relieve constipation. What was the Insulin dose yesterday since morning to night?
PA - Fasting sugar is 194
PA - Actrapid 8U, morning NPH 8U.
At 1.20pm the sugar is 126.
PA - Actrapid 6U, NPH 8U
At 8 pm sugar value is 176 before dinner.
19-10-2024
PPM 1 - Reflex cough? Chest X ray done on 12th October, but not shared here. Reviewing him now in OPD.
PPM 1 - 👍
Clinically he appears to have recovered since 12th and cough subsided.
PPM 2 - That's good.
05-11-2024
PPM 1 - He was sliding and falling from his wheel chair in the OPD now! Quadriparesis with are flexible in all except right knee.
PA - Human actrapid 10U NPH 8U given.
06-11-2024
PA - Fasting sugar value is 111.
Post Lunch value is 452.
PA - The patient was given 8U in the afternoon. Can we give 10U now?
PPM 1 - Yes. Morning how much did you give?
PA - 8U - 8U.
PPM 1 - Please give 10U - 10U in the morning also.
PA - 
Afternoon Post lunch sugar value is 371
PA - Sugar value at 8 pm is 215.
Same dose 8 Human Actrapid and NPH 8 units given sir.
PPM 1 - 👍
08-11-2024
PPM 1 - What is the fasting sugar value today?
PA - 224 sir. Given 10U insulin.
PPM 1 - 👍
PA - At 2pm the value is 214.
PPM 1 - At what time did he have breakfast? 214 sugar value , is it after 2hrs after lunch?
PA - Morning 7 o clock 1 glass milk, 9.30am 4 Idlies. Afternoon lunch rice.
PPM 1 - At what time did you give 10U insulin?
PA - 9.20 am.
03-12-2024
PPM 1 - Reviewed right now in the OPD.
Another good news is that he has started to walk since one month since his craniectomy which was done 3 months back.👇
PPM 1- He also has these black spots on the palm since one month possibly due to a drug induced effect!
PPM 1 - The head looks much better and full instead of the previous sabre look.
Also has diabetes 15 yrs and this current phenotype was different when the diabetes began.
PA - Doctor the patient is not taking his medication and also food.
PPM 1 -
EMR Summaries.
Is he taking the insulin?
How are his blood sugars?
What is he doing all day? Lying in bed?
PA - He is refusing to take any medication as well as food.
PPM 1 - Appears to be having a psychological issue?
PA - Think so.
PPM 1 - Or he could be developing meningoencephalitis and organic brain syndrome and needs to be examined clinically in the OPD asap.
PA - Should I call the caretaker and inform?
PPM 1 - Can text her in telugu here.
PA - Please, meeru yentha thondaraga velaithe antha thondaraga hospital ki theesukuvellandi. Doctor garu chepparu.
Caretaker - Now he ate his food and took his tablets.
Tomorrow will come to the hospital.
Whom should they contact?
PPM 1 - I guess that worked as a threat and he preferred eating rather than coming again to the hospital!
PPM 3 - 😅
He can take general medicine OP slip and come to room no:78
Meeru podhune 9 gantalaki general medicine op tesukuni 78 room ki ravochu akkada nenu vuntanu
18-12-2024
PPM 1 - They have come here many times and even last week!
PA - Are you available at the hospital doctor?
PPM 1 - Yes.
Caretaker - Doctor he has eaten two idlies and taken the medcicne.
PPM 1 - Okay
Looks like he's better so they need not bring him today @PA.
Caretaker - Ok sir today we are coming to the hospital. Should we come to the room number 78?
PPM 1 -
If he's already feeling and looking better today then you need not bring him today. We are available in the OPD daily.
PPM 1 - Mirtazepine sounds okay but memantine may not be a good idea.
EMR Summaries.
First admission EMR summary below:(note how the patient's age and disease duration keeps changing across all 3 admissions.)
Age/Gender : 51 Years/Male
Address :
Discharge Type: Relieved
Admission Date: 24/02/2023 04:05 PM
Name of Treating Faculty
Diagnosis
GRADE III-IV EXTERNAL HAEMORRHOIDS WITH UNCONTROLLED TYPE 2 DM WITH URINARY RETENTION (RESOLVED)?UNDERACTIVE BLADDER, ?DIABETIC CYSTOPATHY -K/C/O DM -II SINCE 12 YRS AND HYPERTENSION SINCE 6 YEARS
Case History and Clinical Findings
PATIENT CAME TO THE CASUALITY WITH COMPLAINTS OF DIFFICULTY IN PASSING URINE SINCE 5 DAYS,C/O PILES SINCE 5 YRS AND C/O BURNING MICTURITION SINCE 6 DAYS HOPI:- PATIENT WAS APPARENTLY ASYMPTOMATIC 5 DAYS AGOTHEN HE DEVELOPED
ABDOMINAL DISTENSION,AND DIFFICULTY IN PASSING URINE SINCE MORNING -(DRIBBLING
OF URINE AND VERY LOW OUTPUT).THE PATIENT WAS CATHETERISED OUTSIDE FOR THIS, PATIENT PASSED URINE AND ABDOMINAL DISTENSION RELIEVED.ON DAY 3 CATHETER WAS REMOVED AND PATIENT WAS PASSED URINE SPONTANEOUSLY 2 TIMES THEREAFTER AND HE WAS DISCHARGED.
PATIENT STILL HAD COMPLAINTS OF DIFFICULTY OF PASSING URINE AND HE AS CATHETERISED TODAY OUTSIDE , HE PASSES URINE AND PRESENTED TO THE CASUALITY WITH CATHETER INSITU
HE IS K/C/O DM SINCE 12 YRS- ON GLIMI M2 PO/OD-IRREGULAR USAGE K/C/O HTN SINCE 6 YRS ON TAB. CLINIDIPINE -IRREGULAR MEDICATION NOT A K/C/O CAD, CVA,EPILEPSY, TB ASTHMA
ON EXAMINATION AT TIME OF ADMISSION THE PATIENT WAS C/C/C
NO PALLOR ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY,PEDAL EDEMA VITALS:-
TEMP-98.7F
BP:- 160/100 MMHG AT TIME OF ADMISSION >130/80 AT TIME OF DISCHARGE ON 2/3/2023
PR:- 73 BPM RR:- 16CPM
CVS:- S1S2+ NO MURMURS RS:- NVBS HEARD
PA- SOFT , NT
CNS :- HMF INTACT, NFND COURSE IN HOSPITAL
IN VIWE OF HIGH SUGARS PATIENT WAS MONITORED WITH 7 POINT PROFLE IN HOSPITAL..INITIALLY HE WAS ON TAB. GLIMI M2 PO/OD WHICH WAS CONVERTED TO TAB. GLIMI M2 PO/BD
THEN TAB GLIMI 0.5 MG PO BD WAS ADDED ON 26.02.2023 AND TAB. VOGLIBOSE 0.2 MG PO OD WAS ADDED ON 28.02.2023
INVIEW OF HIGH BP RECORDINGS , PATIENT WAS ADVISED T,. CLINIDIPINE 10 MG PO OD IN VIEW OF C/O PILES A GENERL SURGERY REFERRAL WAS DONE ON 24.02.23, ON LOCAL EXAMINATIONS GRADE 3 EXTERNAL HAEMORRHOIDS AT 11'O CLOCK POSITION AND 1;0
CLOCK POSITION
GRADE 4 HAEMORRHOIDS WITH BLUISH DISCOLOURATION PRESENT , CONGESTION PRESENT
THEY ADVISED PRONE POSITION AND PLAN FOR HAEMORRHOIDECOMY AFTER REGGRESSION OF ACUTE CONDITION OF HAEMORRHOIDS
IN VIEW OF DIFFICULTY IN PASSING URINE PATIENT WAS TAKEN FOR UROLOGY REFERRAL ON 27.02. 2023.. THEY ADVISED T.TAMSULOSIN 0.4 PO OD AND T. PAN 40 PO OD
Investigation
USG ABDOMEN AND PELVIS :- BILATERAL SUBCENTIMETRIC RENAL CORTICAL CYST BLADDER - DISTENDED WALL THICKNESS- IRREGULAR
PREVOI URINE - 250CC
POST VOID-40CC, INSIGNIFICANT PVR PROSTATE VOLUME -16CC HEMOGRAM :-
HB:- 12G%, TLC:- 10300
PLATELET COUNT:- 3.77 LAKHS/CUMM RFT:-
UREA- 20 CREATININE-1.0 URIC ACID-3.5 CALCIUM-9.7 SODIUM-128 POTASSIUM- 4.4 CHLORIDE-94
Treatment Given(Enter only Generic Name)
1. IV FLUIDS
1. TAB. GLIMI M2 O BD
2. TAB. GLIMIPERIDE 0.5 MG PO BD
3. TAB. VOGLIBOSE 0.2 MG PO OD 4.TAB. CLINIDIPINE 10 MG PO OD 5.TAB.TAMSULOSIN 0.4 MG PO HS Advice at Discharge
PATIENT CAME WITH THE COMPLAINTS OF DIFFICULTY IN PASSING URINE AND PAIN
ABDOMEN SINCE 5 DAYS AND APPROPRIATE INVESTIGATIONS WERE DONE. UROLOGY REFFERAL WAS DONE AND MEDICATIONS WERE ADVISED. PATIENT IS GETING DISCHARGED IN HEMODYNAMICALLY STABLE CONDITION
1. TAB. GLIMI M2 BD
2. TAB. GLIMIPERIDE 0.5 MG PO BD
3. TAB. VOGLIBOSE 0.2 MG PO OD 4.TAB. CLINIDIPINE 10 MG PO OD 5.TAB.TAMSULOSIN 0.4 MG PO HS Follow Up
REVIEW TO GM OPD AFTER 1 WEEK
REVIEW TO GS OPD AFTER 1 WEEK
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: 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
Discharge Date Date: 2/3/2023 Ward: GM WARD
Unit:3
Second Admission:
Age/Gender : 46 Years/Male
Address :
Discharge Type: Relieved
Admission Date: 24/06/2023 03:30 PM
Diagnosis
DIABETIC KETOSIS (RESOLVED) SECONDARY TO ACUTE GASTROENTERITIS (RESOLVED) WITH GIDDINESS SECONDARY TO LATERAL MEDULLARY SYNDROME WITH K/C/O DM SINCE 13 YRS , K/C/O HTN SINCE 1 MONTH
Case History and Clinical Findings
PATIENT CAME TO CASUALTY WITH C/O GIDDINESS ON AND OFF SINCE 5 DAYS. PT WAS APPARENTLY NORMAL 5 DAYS BACK AND THE HE STARTED HAVING GIDDINESS ON AND OFF , INSIDIOUS IN ONSET AND GRADUALLY PROGRESSIVE.
C/O VOMITINGS (4 - 5 EPISODES , WATERY , NON PROJECTILE ,ILIOUS WITH FOOD PARTICLES AS CONTENTS AND WITH BLOOD TINGED . RELIEVED WITH MEDICATION C/O LOOSE STOOLS (4-5 EPISODES ,WATERY , NOT BLOOD STAINED, NON MUCOID , NO
FOUL SMELLING )
C/O PAIN ON RIGHT SIDE OF BODY ALONG WITH WEAKNESS OF RIGHT LOWER LIMB 5 DAYS BACK AND RELIEVED
C/O FACILA PUFFINESS SINCE 5 DAYS , LOW ABCK ACHE SINCE 1 DAY
NO C/O FEVER , PAIN ABDOMEN , DECREASED URINE OUTPUT , PEDAL EDEMA PAST HISTORY
PATIENT VISITED LOCAL HOSPITAL 1 MONTH BACK WITH C/O HEADACHE, SWEATING, GIDDINESS AND WAS DIAGNOSED AS HYPERTENSIVE AND PUT ON MEDICATIONS. PATIENT IS A KNOWN CASE OF DM II SINCE 13 YEARS AND IS ON MEDICATION. NOW USING
GLIMI-M4 FORTE PO/OD(MORNING) AND GLIMI-M3 FORTE PO/OD(NIGHT)
K/C/O HTN SINCE 1 WEEK
THE PATIENT WAS OPERATED FOR HAEMORRHOIDS 20 YEARS BACK NOT A KNOWN CASE OF CAD, BRONCHIAL ASTHMA, EPILEPSY, TB. PERSONAL HISTORY
DIET- MIXED
APPETITE- DECREASED SINCE 5 DAYS SLEEP- ADEQUATE
BOWEL AND BLADDER- REGULAR
ADDICTIONS- BINGE ALCOHOLIC SINCE 13 YEARS.STOPPED CONSUMPTION 6 YEARS BACK- HABITUATED TO SOFT DRINKS
CHEWING TOBACCO SINCE 20 YEARS. NO KNOWN ALLERGIES
FAMILY HISTORY
NO H/O DM IN THE FAMILY GENERAL EXAMINATION
PATIENT WAS EXAMINED IN A WELL LIT ROOM AFTER TAKING INFORMED CONSENT. HE IS CONSCIOUS, COHERENT AND COOPERATIVE; MODERATELY BUILT AND WELL NOURISHED.
NO ICTERUS, CLUBBING, CYANOSIS, LYMPHADENOPATHY, EDEMA.
VITALS ON 24/06/2023BLOOD PRESSURE:170/100 MMHGPULSE PRESSURE: 60 BPMRESPIRATORY RATE: 14CPMTEMPERATURE: AFERBILESPO2: 98% ON ROOM AIRGRBS:428MG/DL
SYSTEMIC EXAMINATION
1. RESPIRATORY SYSTEM : B/L AIR ENTRY PRESENT,NORMAL VESICULAR BREATH SOUND+
2. CARDIOVASCULAR SYSTEM:S1, S2 HEARD, NO MURMURS. 3.ABDOMINAL EXAMINATION: SOFT, NON- TENDER 4.CNS- NO FOCAL NEUROLOGICAL DEFICITS
Investigation
ON 24/06/23
HEMOGRAM HB 11.9 TC 8300 N/L/E/M/B 70/23/2/5/0 PCV 36 MCV 73.6 MCH 24.4 MCHC 33.1
RBC 4.87 PLT 3.49
ABG PH 7.45 PCO2 30.8 PO2 88.2 HCO3 21.1
SERUM ELRCTROLYTES NA+ 142 K+ 4.4 CL- 101 CA IONISED 1.19 SERUM CREATININE 1.0 MG/DL
BLOOD UREA 57 MG/DL RBS 423 MG/DL
CUE PALE YELLOW ,CLEAR ,ACIDIC SPECIFIC GRAVITY 1.010 PUS CELLS 3-4 URINE FOR KETONE BODIES POSITVE
SEROLOGY
HBSAG,HIV 1,2, ANTI HCV -NEGATIVE ON 25/06/23
HEMOGRAM HB 11.3 TC 11200N/L/E/M/B 77/16/1/6/0 PCV 33.7 MCV 74.1 MCH 24.8 MCHC 33.5
RBC 4.55 PLT 3.23
ABG PH 7.43 PC02 28.1 PO2 102 HCO3 18.6
SERUM ELRCTROLYTES NA+ 135 K+ 3.2 CL- 98 CA IONISED 1.13
FBS 81 MG/DL
LIPID PROFILE TOTAL CHOLESTEROL 174MG/DL HDL 47 TAG 197 LDL 126 VLDL 39.4 26/06/2023
SERUM ELECTROLYTES NA+ 139 K+ 3.5 CL- 103 CA IONISED 1.24 27/6/2023
HEMOGRAM HB 12 TC 7600 N/L/E/M/B 62/30/3/5/0 PCV 36.9 MCV 77.5 MCH 25.2 MCHC 32.6
RBC 4.76 PLT 2.79 28/06/23
HEMOGRAM HB 12.3 TLC 10300 N/L/E/M/B 55/36/2/7/0 PCV 37.8 MCV 78.5 MCH 25.5 RBC 4.81
PLT 3.12
29/6/23 HB 11.5 TLC 7200 PCV 35 MCV 78 MCH 25.4 MCHC 32.5RBC 4.53 PLT 2.59 URINE C/S: NO GROWTH
USG GRADE 1 FATTY LIVER MRI BRAIN PLAIN
ACUTE INFARCT IN LATERAL ASPECT OF MEDULLA ON RIGHT SIDE TO RULE OUT WALLENBERG/ LATERAL MEDULLARY SYNDROME 2D ECHO
TRIVIAL TR/AR, NO MR NO RWMA
NO AS/MS
GOOD LV SYSTOLIC FUNCTION
NO DIASTOLIC DYSFUNCTION, NO PAH/PE
OPHTHALMOLOGY REFERRAL FOR FUNDOSCOPY I/V/O DIABETES SINCE 13 YRS :
RT EYE MILD, NON PROLIFERATIVE DIABETIC RETINOPATHY CHANGES NOTED
ADV: STRICT DIABETIC DIET, GLYCEMIC CONTROL, FUNDOSCOPIC EXAMINATION EVERY 6 MONTHS
ENT REFERRAL I/V/O VERTIGO :
ADV: RULE OUT CENTRAL PATHOLOGY FOR NYSTAGMUS, REVIEW WITH REPORTS
Treatment Given(Enter only Generic Name)
IVF NS @100 ML /HR X 7 DAYS IVF 5D @50 ML/HR X1 DAY
INJ KCL 2 AMPOULES IN 500 ML NS IV OVER 5HRS X 1 DAY
INJ HUMAN ACTRAPID INSULIN INFUSION (1 ML+39 ML ) @6 ML/HR X 2 DAYS
INJ HUMAN ACTRAPID INSULIN S/C TID BEFORE MEALS ACCORDING TO GRBS X 5 DAYS INJ NPH S/C BD BEFORE MEALS ACCORDING TO GRBS X5DAYS
INJ PAN 40 IV/BD X 7 DAYS
INJ BUSCOPAN IM/SOS X 6 DAYS TAB TELMA 40 MG PO/OD X 7 DAYS
TAB PROMETHAZINE 25 MG PO/TID X 4 DAYS TAB ECOSPRIN PO/HSX 3 DAYS
TAB SPOROLAC-DS PO /TIDX 3 DAYS SYRUP POTCHLOR 15 ML PO/BD X 3 DAYS
Advice at Discharge
INJ HUMAN ACTRAPID INSULIN S/C TID BEFORE MEALS ACCORDING TO GRBS ( 14-14-12 ) INJ NPH S/C BD BEFORE MEALS ACCORDING TO GRBS ( 12- X- 10 )
TAB PAN 40 PO/OD X 5 DAYS TAB TELMA 40 MG PO/OD
TAB PROMETHAZINE 25 MG PO/TID X 4 DAYS TAB ECOSPRIN PO/HS
SYRUP POTCHLOR 15 ML PO/BD X 5 DAYS TAB MVT PO/OD X 15 DAYS
Follow Up
REVIEW TO GM OPD AFTER 1 WEEK OR 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: 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
Discharge Date Date: 30/6/23 WARD-AMC UNIT- VI
Third admission:
Age/Gender : 50 Years/Male
Address :
Discharge Type: Relieved
Admission Date: 02/09/2024 05:01 AM
Discharge Date DATE:25/09/24 WARD: EMD
UNIT: NEUROSURGERY
Diagnosis
LEFT INTRACEREBRAL HEMMORHAGE WITH INTRAVENTRICULAR EXTENSION WITH GRADE 2 BED SORE OVER B/L GLUETEAL REGION
S/P LEFT FTP DECOMPRESSIVE CRANIECTOMY WITH RIGHT KOCHERS POINT EXTERNAL VENTRICULAR DRAINAGE UNDER GA DONE ON 2/09/2024
Case History
PATIENT PRESENTED TO CASUALITY IN ALTERED STATE C/O VOMITING SINCE 1 DAY ( 6 - 7 EPISODES ), C/O LOOSE STOOLS SINCE 1 DAY ( 9 - 10 EPISODES)
HOPI:
PATIENT WAS APPARENTLY Asymptomatic a DAY AGO THEN HE DEVELOPED VOMITING SUDDEN ONSET ,GRADUALLY PROGRESSIVE ,6- 7 EPISODES FOOD AS CONTENT ,NON BILIOUS ,NON BLOOD TINGED
H/O LOOSE STOOLS SINCE 1 DAY ,NON FOUL SMELLING ,NON BLOOD TINGED, 9 - 10 EPISODES
H/O FEVER 3DAYS AGO SUDDEN ONSET ,ASSOCIATED WITH CHILLS,RIGORS ,LOW GRADE RELIEVED ON MEDICATION
NO H/O PAIN ABDOMEN , CONSTIPATION ,CHEST PAIN,PALPITATIONS ,BURNING MICTURITION ,SEIZURES.
PAST HISTORY:
K/C/O DM SINCE 19 YEARS ON T.GLIMI M2 PO/BD K/C/O HTN SINCE 1 YEAR ON T. TELMA 40 MG OD
K/C/O CVA SINCE 1 YEAR BACK ON T. ECOSPRIN AV 75/10 MG PERSONAL HISTORY:
DIET - MIXED
OCCUPATION - AUTO DRIVER APPETITE - NORMAL
SLEEP - ADEQUATE
BOWEL - IRREGULAR( LOOSE STOOLS 9 - 10 EPISODES) BLADDER - REGULAR
ALLERGIES- NO
STOPPED ALCOHOL CONSUMPTION SINCE 10 YEARS NO SIGNIFICANT FAMILY HISTORY
General Examination:
NO PALLOR, ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY, EDEMA VITALS:
TEMP - 98.6 F PR-80 BPM RR- 19 CPM
BP-110/70MMHG
SPO2 : 96 AT ROOM AIR GRBS: 316 MG
CVS : S1, S2 HEARD.
NO MURMURS
RS : B/L AE +
PA: ABDOMEN IS SCAPHOID , NO TENDERNESS, NO ORGANOMEGALY CNS : NO FND, NO SENSORY OR MOTOR DEFICITS, GCS IS E3V2M5 CENTRAL LINE PLACED IN THE RIGHT SUBCVLAVIAN VEIN ON 3/9/24 TRACHEOSTOMY DONE ON 6/09/204 I/V/O PROLONGED VENTILATION BL0OD TRANSFUSIONS
1 INTRA OP ON 2/9/24
2 TWO TRANSFUSIONS DONE ON 4/9/24 AND 11/9/24 I/V/O LOW HB PATIENT HAS BEEN
EXTERNAL VENTRICULAR DRAIN AND ROMOVACDRAIN HAVE BEEN REMOVED ON 9/9/24
BED SORE DEVELOPED OVER RIGHT GLUTEAL FROM 11/9/24
ON 13/9/24 CULTURE FROM ET TUBE ISOLATED ACINETOBACTER AND KLEBSIELLA BACTERIA ARE BEEN ISOLATED AND ANTIBIOTIC CHANGED ACCORDINGLY
PULMONOLOGY REFFREAL DON EON 19/9/24 1CST
2MONITOR VITALS C/S/B GM ON 24/9/24
REVIEW REFFERAL ON INSULIN USAGE
Investigation
ABG 02-09-2024PH 7.4
PCO2 31.3 PO2107 HCO320.5 St.HCO322.4 BEB-2.4
BEecf-3.1 TCO240.1 O2Sat97.6
O2 Count19
.1LIVER FUNCTION TEST (LFT) 02-09-2024
TOTALBilurubin0.93 mg/dl Direct Bilurubin0.29 mg/dl SGOT(AST)17 IU/L SGPT(ALT)12 IU/L
ALKALINE PHOSPHATASE165 IU/L TOTALPROTEINS6.6 gm/dL ALBUMIN 3.97 gm/dL
A/G RATIO1.51
COMPLETEURINE EXAMINATION (CUE) 02-09-2024
COLOUR Paleyellow APPEARANCEClear
REACTIONAcidic SP.GRAVITY1.010
ALBUMIN+++ SUGAR++++
BILESALTSNi
lBILE PIGMENTSNil PUS CELLS4-5 EPITHELIAL CELLS3-4 RED BLOODCELLS Nil CRYSTALSNil CASTSNil
AMORPHOUS DEPOSITSAbsent OTHERSNil
HBsAg-RAPID 02-09-2024 0AM Negative
Anti HCV Antibodies - RAPID02-09-2024 05:46:AMNon Reactive BLOOD UREA02-09-2024 33 mg/dl
SERUM CREATININE02-09-2024 0.8 MG/DL SERUM ELECTROLYTES (Na, K, C l) 02-09-2024
SODIUM 135mmol/L POTASSIUM 4.4 mmol/L
CHLORIDE 97 mmol/L
ABG 02-09-2024 08:29:PM
PH 7.49
PCO2 25.9
PO2 180
HCO3 19.6 St.HCO322.2 BEB-2.7
BEecf- 3.3 TCO240.7 O2 Sat99.6
O2 Count12.5
RFT 02-09-2024 08:30:PM
UREA37 mg/dl CREATININE0.7 mg/dl URIC ACID3.6 mmol/L
CALCIUM 7.6mg/dl PHOSPHOROUS 4.1 mg/dL
SODIUM 142 mmol/L
POTASSIUM 3.8 mmol/L.
CHLORIDE 102 mmol/L
LIVERFUNCTION TEST (LFT) 02-09-2024 10:11:PM
Total Bilurubin1.20 mg/dl Direct Bilurubin 0.33mg/dL SGOT(AST)15 IU/L SGPT(ALT)12 IU/L
ALKALINEPHOSPHATASE126 IU/L TOTAL PROTEINS 5.0 gm/dl
ALBUMIN 3.1gm/dl A/G RATIO1.75
RFT 02-09-2024 10:11:PM
UREA 48 mg/dl
CREATININE 1.1 mg/dl1 URIC ACI D 3.7 mmol/L
CALCIUM 7.8mg/dl PHOSPHOROUS2.9 mg/dl
SODIUM136 mmol/L POTASSIUM4.2 mmol/L
.CHLORIDE101 mmol/L
COMPLETEBLOOD PICTURE (CBP) 02-09-2 10:11:PM HAEMOGLOBIN10.6 gm/dl
TOTAL COUNT13400 cells/cumm NEUTROPHILS82 % LYMPHOCYTES11 % EOSINOPHILS01 % MONOCYTES06 % BASOPHILS00 %
PLATELET COUNT3.28 SMEAR
microcytichypochromic anemia with neutrophilic leukocytosis
.ABG 03-09-202412:29:AM PH7.45
PCO226.0 PO2139 HCO317.8 St.HCO320.5 BEB-4.8
BEecf-5.4 TCO237.1O2Sat98.8
O2 Count13.0
ABG 03-09-2024 07:44:AM PH7.49
PCO225.9 PO2180 HCO319.6 St.HCO322.2 BEB-2.7
BEecf-3.3 TCO240.7O2 Sat99.6
O2 Count12.5
ABG 03-09-2024 05:43:PM PH7.37
PCO233.4 PO231.9 HCO319.0 St.HCO319.5 BEB-5.1
BEecf-5.3 TCO240.7O2Sat44.6
O2 Count5.6
SERUM ELECTROLYTES (Na, K, C l) 03-09-2024 05:43:PM
SODIUM136mmol/L POTASSIUM3.8 mmol/L
CHLORIDE99 mmol/L ABG 03-09-2024 06:51:PM PH7.520
PCO222.4 PO2133 HCO318.2 St.HCO321.6 BEB-3.4
BEecf-4.3TCO237.6 O2 Sat99.2
O2 Count12.7
ABG 04-09-2024 05:52:AMPH7.43 PCO221.4
PO2137 HCO314.0 St.HCO317.1 BEB-9.0
BEecf-9.5 TCO229.9O2Sat98.9
O2 Count10.9
RFT 04-09-2024 05:52:AM
UREA34 mg/dl CREATININE0.8mg/dl URIC ACID1.9 mmol/L
CALCIUM8.3 mg/dl PHOSPHOROUS2.0 mg/dl
lSODIUM135 mmol/L POTASSIUM3.5mmol/L. CHLORIDE106 mmol/L
SERUM ELECTROLYTES (Na, K, C l)04-09-2024 06:20:PM
SODIUM134 mmol/L145-136 mmol/L POTASSIUM3.6 mmol/L5.1-3.5mmol/L CHLORIDE104 mmol/L98-107 mmol/L ABG 04-09-202409:54:PMPH7.44
PCO224.7 PO284.3 HCO316.8 St.HCO319.7 BEB-5.6
BEecf-6.5 TCO234.4O2Sat95.9
O2 Count14.1
LIVER FUNCTION TEST (LFT) 04-09-2024 09:54:PM
Total Bilurubin0.66mg/dl Direct Bilurubin0.20 mg/dl SGOT(AST)27 IU/L SGPT(ALT)13IU/L
ALKALINE PHOSPHATASE128 IU/L TOTAL PROTEINS5.2 gm/dl
ALBUMIN2.7 gm/dl A/G RATIO1.10
RFT 04-09-2024 09:54:PM
UREA38 mg/dl42-12mg/dl CREATININE0.8 mg/dl1.3-0.9 mg/dl URIC ACID2.1 mmol/L7.2-3.5 mmol/L CALCIUM8.8mg/dl10.2-8.6 mg/dl PHOSPHOROUS2.8 mg/dl
SODIUM139 mmol/L
POTASSIUM3.5 mmol/L.5.1-3.5 mmol/L. CHLORIDE102 mmol/L98-107 mmol/L ABG 04-09-202411:59:PM
PH7.48 PCO226.4 PO299.6 HCO319.5 St.HCO322.1 BEB-2.7
BEecf-3.5
TCO239.9O2Sat97.5
O2 Count13.7
ABG 05-09-202403:14:PM PH7.41
PCO225.8 PO2150 HCO316.4 St.HCO319.1 BEB-6.5
BEecf-7.2 TCO233.7 O2Sat99.
1O2 Count14.9
ABG 05-09-202410:27:PM PH7.41
PCO225.2 PO245.5 HCO315.9 St.HCO318.5 BEB-6.9
BEecf-7.8 TCO232.1O2Sat76.9
O2 Count13.0
LIVER FUNCTION TEST (LFT) 05-09-2024 10:27:PM
Total Bilurubin0.46mg/dl Direct Bilurubin0.11 mg/dl SGOT(AST)22 IU/L LSGPT(ALT)13IU/L
ALKALINE PHOSPHATASE141 IU/L TOTAL PROTEINS4.7 gm/dl
ALBUMIN2.5 gm/dl A/G RATIO1.20
RFT 05-09-2024 10:27:PM
UREA48 mg/dl
CREATINNE1.0 mg/dl
lURIC ACID3.0 mmol/L CALCIUM9.mg/dl PHOSPHOROUS2.5 mg/dl
SODIUM135 mmol/L POTASSIUM3.4 mmol/L.
.CHLORIDE103 mmol/L ABG 06-09-2024 07:14:PM PH7.33PCO226.5
PO2151 HCO313.8 St.HCO316.1 BEB-10.5 BEecf-10.9
TCO229.4O2Sat98.9
O2 Count12.9
ABG 06-09-202410:52:PMPH7.17 PCO238.7
PO2166 HCO313.7 St.HCO313.9 BEB-13.7 BEecf-13.2 TCO230.0 O2Sat98.4
O2 Count13.9
LIVER FUNCTION TEST (LFT) 06-09-2024 10:52:PM
Total Bilurubin2.04mg/dL Direct Bilurubin0.40 mg/dl SGOT(AST)25 IU/L SGPT(ALT)21IU/L
ALKALINE PHOSPHATASE178 IU/L TOTAL PROTEINS5.5 gm/dl
ALBUMIN2.6 gm/dl
A/G RATIO0.92
RFT 06-09-2024 10:52:PM
UREA67 mg/dl CREATININE0.9 mg/dl URIC ACID3.2 mmol/L
CALCIUM9.5mg/dl10.2-8.6 mg/dl PHOSPHOROUS4.3 mg/dl
SODIUM139 mmol/L POTASSIUM3.6 mmol/L.
.CHLORIDE106 mmol/L ABG 07-09-2024 04:42:AM PH7.39
PCO215.2 PO2102 HCO39.1 St.HCO313.3 BEB-14.3 BEecf-15.2
TCO219.2O2Sat97.3
O2 Count12.5
ABG 07-09-202406:16:AM PH7.12
PCO247.8 PO272.0 HCO315.0 St.HCO313.6 BEB-14.2 BEecf-12.6
TCO232.2O2Sat86.1
O2 Count16.2
ABG 07-09-202408:20:AM PH7.41
PCO226.6 PO285.6
HCO316.9 St.HCO319.2 BEB-6.3
BEecf-6.8 TCO235.5 O2 Sat96.8
O2 Count12.1
ABG 07-09-202405:31:PM PH7.38
PCO225.8 PO264.1 HCO315.2 St.HCO317.5 BEB-8.4
BEecf-8.8 TCO232.6O2Sat91.0
O2 Count10.1
ABG 07-09-202407:05:PM PH7.38
PCO226.0 PO2149 HCO315.4 St.HCO318.0 BEB-8.0
BEecf-8.6 TCO231.7O2Sat98.9
O2 Count15.3
ABG 08-09-202401:15:AM PH7.45
PCO224.0 PO280.5 HCO316.7 St.HCO319.8 BEB-5.5
BEecf-6.5 TCO233.8 O2Sat96.3
O2 Count15.0
LIVER FUNCTION TEST (LFT) 08-09-2024 01:15:AM
Total Bilurubin2.07mg/dl Direct Bilurubin0.48 mg/dl SGOT(AST)18 IU/L SGPT(ALT)16IU/L
ALKALINE PHOSPHATASE161 IU/L TOTAL PROTEINS5.3 gm/dl ALBUMIN2.8 gm/dL
A/G RATIO1.17
RFT 08-09-2024 01:15:AM
UREA80 mg/dl CREATININE1.0 mg/dl URIC ACID2.8 mmol/L
CALCIUM9.4mg/dl10.2-8.6 mg/dl PHOSPHOROUS2.1 mg/dl
SODIUM140 mmol/L POTASSIUM3.8 mmol/L.
.CHLORIDE101 mmol/L ABG 08-09-2024 05:32:PM PH7.41
PCO225.3 PO2134 HCO315.9 St.HCO318.4 BEB-7.3
BEecf-7.7 TCO233.9 O2Sat98.8
O2 Count11.3
LIVER FUNCTION TEST (LFT) 08-09-2024 10:39:PM
Total Bilurubin3.11mg/dl Direct Bilurubin0.45 mg/dl SGOT(AST)22 IU/L SGPT(ALT)25IU/L
ALKALINE PHOSPHATASE214 IU/L TOTAL PROTEINS5.6 gm/dl
ALBUMIN2.8 gm/dl A/G RATIO1.04
RFT 08-09-2024 10:39:PM
UREA72 mg/dl CREATININE0.9 mg/dl URIC ACID2.6 mmol/L
CALCIUM9.9mg/dl PHOSPHOROUS2.5 mg/dl
SODIUM145 mmol/L POTASSIUM3.3 mmol/L. CHLORIDE104 mmol/L LABG 08-09-2024 10:39:PM PH7.35
PCO217.0 PO2149 HCO39.2 St.HCO313.3 BEB-14.6 BEecf-15.5 TCO219.2 O2Sat98.7
O2 Count15.3
ABG 08-09-202410:40:PM PH7.41
PCO223.5 PO2133 HCO314.8 St.HCO317.7
BEB-8.3
BEecf-8.9 TCO231.1 O2Sat98.7
O2 Count12.3
ABG 08-09-202410:47:PM PH7.40
PCO230.0 PO2138 HCO318.4 St.HCO320.2 BEB-5.1
BEecf-5.4 TCO239.0
O2Sat98.9O2 Count12.1
COMPLETE URINE EXAMINATION (CUE) 09-09-202406:12:AMCOLOURPale yellow APPEARANCEClear
REACTIONAcidic SP.GRAVITY1.010 ALBUMIN+++ SUGAR+++
BILE SALTSNil BILE PIGMENTSNi lPUS CELLS3-4
EPITHELIAL CELLS2-3 RED BLOOD CELLSNil CRYSTALSNil CASTSNil
AMORPHOUSDEPOSITSAbsent OTHERSNil
ABG 09-09-202410:20:PM PH7.46
PCO223.7 PO2134
HCO316.8 St.HCO319.8 BEB-5.6
BEecf-6.3 TCO235.3O2Sat99.2
O2 Count12.2
RFT 09-09-2024 10:20:PM
UREA68 mg/dl CREATININE0.8mg/dl URIC ACID2.1 mmol/L
CALCIUM9.6 mg/dl PHOSPHOROUS2.9 mg/dl
SODIUM142 mmol/L POTASSIUM3.2mmol/L CHLORIDE106 mmol/L ABG 09-09-202410:21:PM PH7.41
PCO223.0 PO2159 HCO314.3 St.HCO316.9 BEB-9.2
BEecf-9.5 TCO230.9 O2Sat99.1
O2 Count9.7
COMPLETE URINE EXAMINATION (CUE) 09-09-2024 11:11:PM
COLOURPaleyellow APPEARANCECloudy REACTIONAcidic SP.GRAVITY1.010 ALBUMIN++ SUGAR++ BILESALTSNil
BILE PIGMENTSNil PUS CELLS5-6 EPITHELIAL CELLS1-2
RED BLOODCELLSplenty CRYSTALSNil
CASTSNil
AMORPHOUS DEPOSITSAbsentOTHERSNiL LIVERFUNCTION TEST (LFT) 10-09-2024 09:35:AM
Total Bilurubin0.84 mg/dl Direct Bilurubin0.19mg/dl SGOT(AST)36 IU/L SGPT(ALT)34 IU/L
ALKALINEPHOSPHATASE225 IU/L TOTAL PROTEINS5.2 gm/dl
ALBUMIN2.7gm/dl A/G RATIO1.06
ABG 10-09-202409:09:PM PH7.37
PCO223.2 PO2154 HCO313.1 St.HCO315.7 BEB-10.9 BEecf-11.2 TCO228.3 O2Sat98.9
O2 Count10.2
LIVER FUNCTION TEST (LFT) 11-09-2024 12:27:AM
Total Bilurubin0.51mg/dl Direct Bilurubin0.16 mg/dL SGOT(AST)27 IU/L SGPT(ALT)34IU/L
ALKALINE PHOSPHATASE255 IU/L TOTAL PROTEINS5.4 gm/dl
ALBUMIN2.6 gm/dl A/G RATIO0.97
RFT 11-09-2024 12:27:AM
UREA70 mg/dl CREATININE0.8 mg/dl
lURIC ACID2.1 mmol/L CALCIUM9.2mg/dl PHOSPHOROUS2.5 mg/dl
SODIUM142 mmol/L POTASSIUM3.0 mmol/L. 2024 12:28:AM
PH7.42 PCO223.8 PO2108 HCO315.3 St.HCO318.0 BEB-7.8
BEecf-8.3 TCO232.6 O2Sat97.8
O2 Count10.9
ABG 11-09-2024 07:59:PM PH7.46
PCO218.6 PO295.5 HCO313.1 St.HCO317.4 BEB-8.8 BEecf-10.0 TCO226.7 O2 Sat97.6
O2 Count14.9
SERUMELECTROLYTES (Na, K, C l) 11-09-2024 07:59:PM
SODIUM146 mmol/L
POTASSIUM3.5 mmol/L CHLORIDE104 mmol/L ABG 11-09-2024 10:25:PM PH7.47
PCO220.9 PO2118 HCO315.0 St.HCO318.7 BEB-7.0
BEecf-8.0 TCO230.9 O2Sat98.6
O2 Count13.6
LIVER FUNCTION TEST (LFT) 11-09-2024 10:25:PM
Total Bilurubin0.89mg/dl Direct Bilurubin0.20 mg/dl SGOT(AST)19 IU/L SGPT(ALT)29IU/L TASE242 IU/L
TOTAL PROTEINS6.2 gm/
ALBUMIN3.30 gm/dl A/G RATIO1.14
RFT 11-09-2024 10:25:PM
UREA69 mg/dl CREATININE0.8 mg/dl
lURIC ACID2.3 mmol/L CALCIUM9.3mg/dl10.2-8.6 mg/dl PHOSPHOROUS2.3 mg/dl
SODIUM145 mmol/L
POTASSIUM3.4 mmol/L.CHLORIDE106 mmol/L ABG 12-09-2024 07:08:PM
PH7.45PCO220.4 PO266.0HCO314.1 St.HCO318.1
BEB-7.7
BEecf-9.1 TCO228.2 O2Sat91.8
O2 Count15.8
ABG 13-09-202404:17:AM PH7.46
PCO215.5 PO2107 HCO311.0 St.HCO316.1 BEB-10.6 BEecf-12.2 TCO222.1 O2Sat97.9
O2 Count16.2
LIVER FUNCTION TEST (LFT) 13-09-2024 04:17:AM
Total Bilurubin0.71mg/dl Direct Bilurubin0.18 mg/dl SGOT(AST)19 IU/L SGPT(ALT)29IU/L
ALKALINE PHOSPHATASE286 IU/L TOTAL PROTEINS7.3 gm/dl ALBUMIN3.5 gm/dL
A/G RATIO0.94
RFT 13-09-2024 04:17:AM
UREA98 mg/dl CREATININE1.1 mg/dl URIC ACID3.1 mmol/L LCALCIUM10.0mg/dl PHOSPHOROUS3.6 mg/dl
SODIUM140 mmol/L POTASSIUM3.3 mmol/L CHLORIDE106 mmol/L
Complete Urine EXAMINATION (CUE) 13-09-2024 10:33:AM
COLOURPaleyellow APPEARANCEClear
REACTIONAcidic SP.GRAVITY1.010 ALBUMIN+++ SUGAR++ BILESALTSNil BILE PIGMENTSNil PUS CELLS4-8
EPITHELIAL CELLS3-4 RED BLOODCELLSNil CRYSTALSNil CASTSNil
AMORPHOUS DEPOSITSAbsent OTHERSNil
ABG 13-09-202402:45:PM PH7.36
PCO217.8 PO2137 HCO310.0 St.HCO314.4 BEB-13.3
BEecf-14 TCO219.9 O2 Sat98.5
O2 Count18.8
ABG 13-09-202409:28:PM PH7.38
PCO214.8 PO2107 HCO38.6 St.HCO313.1 BEB-14.8
BEecf-15.9 TCO217.8O2Sat97.5
O2 Count14.8
RFT 13-09-2024 11:29:PM
UREA112 mg/dl lCREATININE0.8mg/dl URIC ACID2.9 mmol/L
LCALCIUM9.9 mg/dl PHOSPHOROUS2.6 mg/dl
SODIUM141 mmol/L POTASSIUM3.6mmol/L. CHLORIDE105 mmol/L ABG 14-09-202406:58:PM PH7.27
PCO239.9 PO2141 HCO318.0 St.HCO318.1 BEB-7.8
BEecf-7.6 TCO238.7 O2Sat98.6
O2 Count13.2
ABG 14-09-202409:14:PMPH7.15 PCO247.3
PO248.7 HCO315.9 St.HCO314.5 BEB-12.3 BEecf-11.3
TCO234.9O2Sat71.2
O2 Count11.0
RFT 14-09-2024 11:06:P
UREA80 mg/dl
CREATININE0.8mg/dl URIC ACID2.3 mmol/L
CALCIUM9.5 mg/dl PHOSPHOROUS2.4 mg/dl
lSODIUM145 mmol/ LPOTASSIUM4.mmol/L
.CHLORIDE105 mmol/L ABG 14-09-202411:28:PM PH7.47
PCO228.1 PO2108 HCO320.4 St.HCO322.6 BEB-2.1
BEecf-2.7 TCO242.4 O2Sat98.3
O2 Count12.6
ABG 15-09-202405:23:PM PH7.53
PCO228.7 PO2262 HCO324.1 St.HCO326.4 BEB2.2
BEecf1.5 TCO248.9 O2Sat99.8
O2 Count14.7
LIVER FUNCTION TEST (LFT) 16-09-2024 06:28:AM
Total Bilurubin0.92mg/dl Direct Bilurubin0.15 mg/dl SGOT(AST)15 IU/L SGPT(ALT)13IU/L
ALKALINE PHOSPHATASE184 IU/L TOTAL PROTEINS5.4 gm/dl
ALBUMIN2.54 gm/dl A/G RATIO0.89
RFT 16-09-2024 06:28:AM
UREA51 mg/dl CREATININE0.7 mg/dL URIC ACID2.4 mmol/L
CALCIUM9.2mg/dl PHOSPHOROUS2.4 mg/dl
SODIUM142 mmol/L POTASSIUM3.8 mmol/L. CHLORIDE104 mmol/L ABG 16-09-2024 08:15:AM PH7.50
PCO233.4 PO2101 HCO326.0 St.HCO327.3 BEB3.2
BEecf2.9 TCO253.8 O2Sat98.1
O2 Count12.3
ABG 16-09-202407:29:PM PH7.53
PCO230.9 PO2106 HCO326.1 St.HCO327.8 BEB3.8
BEecf3.4 TCO254.0 O2Sat98.6
O2 Count12.0
LIVER FUNCTION TEST (LFT) 16-09-2024 10:18:PM
Total Bilurubin1.25mg/dl Direct Bilurubin0.45 mg/dl SGOT(AST)17 IU/L SGPT(ALT)14 IU/L
ALKALINE PHOSPHATASE183 IU/L TOTAL PROTEINS4.8 gm/dl
ALBUMIN2.30 gm/dl A/G RATIO0.92
RFT16-09-2024 10:18:PM
UREA54 mg/dl CREATININE0.7 mg/dl
lURIC ACID2.0mmol/L CALCIUM9.4 mg/dl PHOSPHOROUS2.6 mg/dl
SODIUM134 mmol/L POTASSIUM3.6 mmol/L.
.CHLORIDE98mmol/L LABG 17-09-202407:25:PM PH7.48
PCO234.5 PO295.1 HCO325.4 St.HCO326.5 BEB2.4
BEecf2.2 TCO253.5 O2Sat97.7
O2 Count11.3A
BG 18-09-202405:03:AM PH7.484
PCO231.0 PO2181
HCO323.0 St.HCO325.1 BEB0.8
BEecf-0.1 TCO244.4 O2Sat99.3
O2 Count13.9
LIVER FUNCTION TEST (LFT) 18-09-2024 06:42:AM
Total Bilurubin1.14mg/dl Direct Bilurubin0.18 mg/dl SGOT(AST)131 IU/L SGPT(ALT)113IU/L
ALKALINE PHOSPHATASE237 IU/L TOTAL PROTEINS5.1 gm/dl
ALBUMIN2.43 gm/dl lA/G RATIO0.91
RFT 18-09-2024 06:42:AM
UREA57 mg/dl CREATININE0.8 mg/dl
lURIC ACID2.2 mmol/L CALCIUM9.8mg/dl PHOSPHOROUS2.8 mg/dl
SODIUM135 mmol/L POTASSIUM3.7 mmol/L. CHLORIDE100 mmol/L ABG 18-09-2024 05:49:PM PH7.51
PCO231.3 PO293.0 HCO325.4 St.HCO327.2 BEB3.1
BEecf2.5 TCO251.0O2Sat97.6
O2 Count15.0
ABG 19-09-202401:43:AM PH7.45
PCO223.4 PO2108 HCO316.2 St.HCO318.2 BEB-7.4
BEecf-7.0 TCO236.6
O2Sat98.3O2 Count4.1 RFT 19-09-2024 01:43:AM
UREA42 mg/dl CREATININE0.8 mg/dL URIC ACID2.0 mmol/L CALCIUM8.3 mg/DL PHOSPHOROUS2.8 mg/dl
SODIUM136 mmol/L POTASSIUM3.4mmol/L.
CHLORIDE98 mmol/L ABG 19-09-202406:11:PM PH7.58
PCO226.2 PO2119 HCO324.7 St.HCO327.3 BEB3.1
BEecf2.6 TCO251.1 O2Sat99.5
O2 Count11.6
LIVER FUNCTION TEST (LFT) 20-09-2024 03:03:AM
Total Bilurubin0.65mg/dl Direct Bilurubin0.19 mg/dl
SGOT(AST)26 IU/L SGPT(ALT)42IU/L
ALKALINE PHOSPHATASE203 IU/L TOTAL PROTEINS4.9 gm/dl
ALBUMIN2.31 gm/dl A/GRATIO0.89
RFT 20-09-2024 03:03:AM
UREA28 mg/dl42-12 mg/dl CREATININE0.7 mg/dl1.3-0.9mg/dl URIC ACID2.4 mmol/L
CALCIUM8.2 mg/dl PHOSPHOROUS2.2mg/dl
SODIUM134 mmol/L POTASSIUM3.9 mmol/L.
CHLORIDE94 mmol/L ABG 20-09-202408:13:AM PH7.51
PCO228.1 PO2106 HCO322.7 St.HCO325.0 BEB0.7
BEecf0.0 TCO246.7 O2Sat98.3
O2 Count13.0
ABG 20-09-202411:14:AM PH7.49
PCO232.0 PO283.9 HCO324.4 St.HCO326.0 BEB1.8
BEecf1.4
TCO250.3 O2Sat96.4
O2 Count13.1
ABG 20-09-202412:46:PM PH7.45
PCO226.4 PO279.0 HCO318.2 St.HCO321.2 BEB-3.8
BEecf-5.1 TCO235.1 O2Sat94.9
O2 Count19.4 PH7.49 PCO228.9 PO274.0 HCO322.0 St.HCO324.0 BEB-0.4
BEecf-0.9 TCO245.7 O2 Sat94.7
O2 Count11.7
ABG 20-09-202406:42:PM PH7.48
PCO227.7 PO2107 HCO320.7 St.HCO323.1 BEB-1.5
BEecf-2.3 TCO242.0O2Sat98.3
O2 Count14.4
RFT 21-09-2024 06:57:AM
UREA37 mg/dl CREATININE0.8mg/dl URIC ACID2.0 mmol/L
CALCIUM9.2 mg/dl PHOSPHOROUS2.5 mg/dl
SODIUM135 mmol/L POTASSIUM3.6mmol/L
CHLORIDE99 mmol/L ABG 21-09-202411:11:PM PH7.51
PCO223.6 PO283.9 HCO318.9 St.HCO322.2 BEB-2.6
BEecf-3.7 TCO238.2 O2Sat96.7
O2 Count14.3
ABG 22-09-202405:41:AM PH7.46
PCO229.9 PO297.0 HCO321.4 St.HCO323.3 BEB-1.3
BEecf-1.8 TCO244.5 O2Sat97.7
O2 Count12.5
LIVER FUNCTION TEST (LFT) 22-09-2024 09:58:PM
Total Bilurubin0.90mg/dl Direct Bilurubin0.18 mg/dl
SGOT(AST)14 IU/L SGPT(ALT)19IU/L
ALKALINE PHOSPHATASE196 IU/L TOTAL PROTEINS5.5 gm/dl
ALBUMIN2.5 gm/dl A/G RATIO0.85
RFT 22-09-2024 09:58:PM
UREA30 mg/dl CREATININE0.6 mg/dl URIC ACID3.4 mmol/L
CALCIUM8.8mg/dl PHOSPHOROUS2.0 mg/dl
SODIUM135 mmol/L POTASSIUM3.9 mmol/L. CHLORIDE102 mmol/L
2D ECHO DONE ON 3/9/24 BEDSIDE NO RWMA MILD LVH
TRIVIAL AR/MR
SCLEROTIC AV;NOP AS/MS IAS-INTACXT EF=66 GOOD LV SYSTLOIC FUNCTION GRADE 1 DIASTOLIC DYSFUNCTION
IVC SIZE NON COLLAPSING
Treatment Given
RX
EMERGENCY DECOMPRESSION CRANIECTOMY WITH EVD
.HEAD END ELEVation 30 DEGEREES WITH PROPPED UP POSITION
.ORAL FEEDS LIQUID DIET IVF NS 80ML/HR
INJ PIPTAZ IV/BD X 5DAYS
INJ AMIKACIN500MG IV/OD X 5DAYS INJMEROPENAMX9 DAYS
INJ VANCOMYCIN X5DAYS
INJ GENTAMYCIN 8MG SLOW IV IN 100ML NS/BD X10 DAYS
.INJ LEVIPIL 500MG IV/BD
.INJ PCM 6GM IV/TID INJ PAN 40MG IV/BD
.INJ OPTINEURON IV/OD
.SYR GLYCEROL 20ML IV/TID REGULAR POSTURAL CHANGE CHEST PHYSIOTHERAPY
.INJ ASTYMIN FORTE IV/TID
.MGSO4 DRESSING FOR LEFT LOWER LIMB
Advice at Discharge
1 DIABETIC DIET
2RYELES TUBE FEEDING (MILK+PROTEIN POWDER )
3TAB FEROPENAM 300MG PO/BD X7DAYS
4 TAB LEVIPIL 500 MGPO/BD X7DAYS TAB PAN 40MG PO/OD/BBF X 7 DAYS 5ORAL GLYCEROL 20 ML PO TID X7DAYS
6REGULAR POSTURAL CHANGEAND CHEST PHYSIOTHERAPY
7GRBS TO BE MONITORED AT HOME BOTH PRE AND POST MEALS
9 INJ HAI S.C/TID (4U-4U-4U)
10 OINTMENT POVIDINE IODINE FOR LOCAL APPLICATION
11TAB TELMA 40 MG PO/OD
Follow Up
REVIEW NEUROSURGERY OP AFTER 1 WEEK
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: 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
25-12-2024
PA - Today's Urine test report sir..
PPM 1 - 30-35 pus cells
8-10 RBCs
Suggestive of foleys catheter in situ.
15-01-2025
PA -
[14-03-2025 21:22] Caretaker: Left leg shivering sir
[14-03-2025 21:34] Caretaker: Left legu nilabetinapudu. Vonukuthundhi. 2nimsalu vonukuthundhi
ekkuva nidra pothundu. 2des nuchi nidra pothundu.
[14-03-2025 21:40] PA: Doctor, when the patient is standing (with help) his left leg is having
imbalance. Since two days he is sleeping almost all the time.
[15-03-2025 09:19] PPM 1: It's due to his neurological issues.
However I'm wondering why he's having more drowsiness.
Can they share his hourly activities of yesterday from morning awakening till night sleep?
[15-03-2025 09:21] PA: @Caretaker garu, patient Ninna poddunna ninchi rathri padukune dhaka yem
chesaro koncham vivaramga share cheyyandi
[15-03-2025 09:26] Caretaker: Adi maku ala thelusundi sir athanu ame cheppalenu parisithula uvvadu
kada
[15-03-2025 09:47] PPM 1: Hourly
Can use a link to illustrate how others have done it before
[15-03-2025 10:41] PA: Intlo vallu cheppagalaru kadaa.
[15-03-2025 19:34] PA: Food thintunnadu water thaguthundu kani nilabadadam ledu mabbu chala undi
sir urike padukuntund nilabaduthe kalu vanukuthundi
[15-03-2025 21:08] PPM 1: Mellaga physiotherapy cheyali. Mellaga melliga saripotundi
[15-03-2025 21:28] PPM 2: Ivi avthunappudu sugar entha undey?
[15-03-2025 21:29] PPM 2: Okasari BP inka pulse chusi cheppandi
[15-03-2025 21:29] PPM 2: Looks like Diabetic Dysautonomia to me.
Abdominal binders can help with symptoms?
[15-03-2025 21:30] PA: Bp121/89
[15-03-2025 21:31] PPM 2: Okay. Adey time lo pulse rate entha?
[15-03-2025 21:31] PA: Sugar 550
[15-03-2025 21:31] PPM 2: Idi reason neersaniki
[15-03-2025 21:31] PPM 2: Insulin edi isthunaru?
[15-03-2025 21:32] PA: Human actrapid
[15-03-2025 21:32] PPM 2: Okay.
[15-03-2025 21:32] PA: 7units
[15-03-2025 21:32] PPM 2: Okay 10 units ivvandi Actrapid ippudu
[15-03-2025 21:33] PPM 2: Idi paduko petti chusara nilapetti ah?
[15-03-2025 21:33] PPM 2: Baga water taginchali. Lekapothe dehydration avthadi
[15-03-2025 21:34] PA: Padukunnapudu chusinam
[15-03-2025 21:35] PA: Water bagha thisukuntundu
[15-03-2025 21:36] PA: Nph 10 units
[15-03-2025 21:36] PPM 2: Okay. 10 units Actrapid insulin ivvandi
[15-03-2025 21:36] PPM 2: NPH kadu. ACTRAPID
[15-03-2025 21:37] PA: Ok
[15-03-2025 21:38] PPM 2: Photo pettandi insulin di
[15-03-2025 21:38] PPM 2: Icchaka. Nilapadey opika untey, nilapetti BP chudandi, Pulse rate kuda
[15-03-2025 21:42] PPM 2: Yes good idey
[15-03-2025 21:45] PA: 7 units echina tharuvatha food thinnadu kada sir epudu evvacha
sir
[15-03-2025 21:45] Aditya: Ippudu sugar 550 ne kada ?
[15-03-2025 21:45] PA: yes sir
[15-03-2025 21:45] PPM 2: Yes aithe ivvandi
[15-03-2025 21:46] PA: thinaka mundhu echinam kada sir
[15-03-2025 21:47] PPM 2: Parvaledu. EM kadu
[15-03-2025 21:47] PPM 2: Thinaka mundhu icchindi saripoledu. Anduke extra dose ivvalsi vasthondi
[15-03-2025 21:47] PA: antha evvali sir
[15-03-2025 21:48] PPM 2: ☝🏽10U
[15-03-2025 21:50] PA: 7 echinam kada sir epudu 3 evvala sir
[15-03-2025 21:51] PPM 2: Ledu 550 ki 10 ivvali
[15-03-2025 21:51] PA: Ok
[16-03-2025 00:00] PPM 2: Sugar entha undi ippudu?
[18-03-2025 12:27] PPM 1: Reviewing the patient now in OPD
They are unable to communicate
Most of his sugars appear to be above 500 everyday!
[19-03-2025 08.28] PA: 289mg/dl
[19-03-2025 08:29] PPM 1: Fasting?
Ninna ratri enta iccharu?
[19-03-2025 08:33] PA: Human actrapid 8 unit
Nph 13 unit
[19-03-2025 08:34] PA: Enta evalli sir
[19-03-2025 08:51] PPM 1: Ippudu same ivvandi.
Two hours taruvata sugar share cheyandi
[19-03-2025 08:52] PA: Ok sir
[19-03-2025 21.37] PA: BP 122/85, PR 90, GRBS 420mg/dl
2 pm 380mg/dl, Human actrapid 13U
[20-03-2025 00:12] PPM 2: Rice kakanda inka emi nacchuthayi ayinaki ?
[20-03-2025 08:09] PPM 1: 4PM lo sugar enta wocchindi ninna? Aa taruwata?
[20-03-2025 08:12] PPM 1: Ninna two hours taruwata sugar cheye ledu kada?
Ninna breakfast mundu 8+13 icchi taruwata sugar enta taggindi teliya ledu kada?
Ninna lunch 12 PM lo plain insulin 13U icchi taruwata chesara?
[20-03-2025 10:07] PA: 244
Sugar
Antha evvali
Sir
[22-03-2025 20.23] PA: 
[22-03-2025 20:26] PPM 1: Sugar manchi control ledu andukane
[22-03-2025 20:28] PA: Adiena medicine chepandi sir
[22-03-2025 20:29] PA: Tablet iena ointment unte chepandi sir
[22-03-2025 20:29] PA: Nidra povadam ledhu sir
[22-03-2025 20:53] PPM 1: Sugar control manchi kavali
Sugar roju ki parighadam, anni tinak rondu ghanta taruwata chepte dose marchtamu
[27-03-2025 08:43] PPM 1: We reviewed him in our Tuesday OPD two days back for pedal edema.
His altered sensorium evaluated in the previous OPD visit weeks ago was much better and even at that
time it was attributed to poor blood sugar control and metabolic encephalopathy and once his patient
advocate was informed of the need to be more diligent with sharing his blood sugars so that we could
titrate his insulin more meticulously he followed the advice for a few days and his blood sugars and
sensorium optimised!
@~PPM3 @~PPM4 would you be able to share the report of his serum albumin and chest X-ray, ECG
we obtained on Tuesday to evaluate for hypoalbuminemia and chronic heart failure?
[27-03-2025 09:18] PPM 4: Yes sure sir, might not be possible to upload, ECG, others I'll
check and upload
[27-03-2025 09:39] PPM 3: I asked for ECG sir
They are not responding.
His CUE was showing 4+ Albumin sir.
[27-03-2025 10:05] PPM 1: This is interesting! And you said just now face to face that his serum
albumin was 3.4!
So is he in an early phase of glomerular injury?
[03-06-2025 12.38] PPM 1: Reviewed him in OPD now:
His sugars had increased to high on the glucometer on 1/6/25 and he has a left heel ulcerations which appears inflammatory necrotic.
[03-06-2025 12.39] PPM 1: @PPM5 will be good to get the LLMs to prepare a problem list of all our individual clinical complexity patients
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