28F With Type 1 Diabetes Hypertension Renal Failure Telangana PaJR

 

19-02-2025

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.

Afternoon ward bench and bedside.

Bedside questions: 28F with type 1 diabetes and getting mixtard 5U twice daily for 6 years was being evaluated for hypoglycemia in the district hospital 2 years back when they also noticed Hypertension to the tune of 180 systolic (they can't recall the diastolic) and then was on antihypertensives but they didn't know anything about her creatinine then. Six months back was operated for gall stones and still no one informed them about her creatinine. Only one month back she developed pedal edema along with shortness of breath and during that time when she was admitted again in the district hospital her creatinine was told to be 5. 

Over-all her main problem appears to be heart failure as echocardiography also shows severe LV dysfunction but then whether it's due to microvascular coronary artery disease in her 20s secondary to her type 1 diabetes is the question.

Again what's the reason for her accompanying renal failure? Is it type 1 diabetes or is it what in common parlance these days is called NDKD non diabetic kidney disease (due to unexplained immune dysfunction)?

Bench questions: 

When we asked @PPM2 and or his and later batches to document this sign that we were noticing in most ECGs with LVH particularly the way the r and S waves overlap around each we didn't realise guys like Seaman in other colleges were also noticing the same and had probably published it before we could even get someone to collate all the ECGs write it up, Seaman's team had done it. 

Now in this particular patient's ECG as well as others as pointed out by @PPM3 we have noticed that the Seaman's sign is visible only in a certain ECG machines and paper. It's never visible in the bigger ECG machines which use the bigger paper!

PPM 1 - 👇Link to echocardiography of the patient.

https://photos.app.goo.gl/CrFTsQ3fHEaQbw9H9