Thursday June 27, 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 PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
DISCHARGE SUMMARY ***
Pay Type: Paying
Age/Gender: 27 Years/Male
Address:
Discharge Type: Relieved
Admission Date: 10/06/2024 09:46 AM
Pay Type: Paying
Age/Gender: 27 Years/Male
Address:
Discharge Type: Relieved
Admission Date: 10/06/2024 09:46 AM
Diagnosis
HYPOGLYCEMIC SEIZURES
TYPE 1 DM SINCE 15 YRS
SEIZURE DISORDER 15 YRS AGO
ANEMIA [IDA-NUTRITIONAL]
HYPOTHYROIDISM SINCE 2 YRS
ANEMIA [IDA-NUTRITIONAL]
HYPOTHYROIDISM SINCE 2 YRS
Case History and Clinical Findings
C/O SEIZURES 1 EPISODE ONE HOUR AGO
HOPI: PATIENT WAS APPARENTLY ASYMPTOMATIC 1 HR AGO THEN HE DEVELOPED
SEIZURES 1 EPISODE OF VOMITING, NON-PROJECTILE, NON-BILIOUS FOOD AS CONTENT
SEIZURES 1 EPISODE OF VOMITING, NON-PROJECTILE, NON-BILIOUS FOOD AS CONTENT
NO H/O FEVER/COLD/COUGH
NO H/O POST ICTAL CONFUSION N
NO H/O GIDDINESS
NO H/O ABDOMINAL PAIN
NO H/O CHEST PAIN CHEST TIGHTNESS
NO H/O SOB, ORTHOPNEA, PND
NO H/O BOWEL AND BLADDER ABNORMALITIES
NO H/O BLEEDING MANIFESTATIONS
PAST HISTORY
NO H/O POST ICTAL CONFUSION N
NO H/O GIDDINESS
NO H/O ABDOMINAL PAIN
NO H/O CHEST PAIN CHEST TIGHTNESS
NO H/O SOB, ORTHOPNEA, PND
NO H/O BOWEL AND BLADDER ABNORMALITIES
NO H/O BLEEDING MANIFESTATIONS
PAST HISTORY
K/C/O DM ON MIXTARD 20 IU 15 years
K/C/O SEIZURES 10 YRS BACK
K/C/O Hypothyroidism ON THYRONORM 100 MG
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PERSONAL HISTORY:
DIET - MIXED
APPETITE - NORMAL
SLEEP - ADEQUATE
BOWEL& BLADDER MOVEMENTS - REGULAR
ADDICTIONS - NIL
K/C/O SEIZURES 10 YRS BACK
K/C/O Hypothyroidism ON THYRONORM 100 MG
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PERSONAL HISTORY:
DIET - MIXED
APPETITE - NORMAL
SLEEP - ADEQUATE
BOWEL& BLADDER MOVEMENTS - REGULAR
ADDICTIONS - NIL
GENERAL PHYSICAL EXAMINATION:
PATIENT IS CONSCIOUS, COHERENT &COOPERATIVE, WELL ORIENTED TO TIME AND PLACE.
NO PALLOR/ ICTERUS / CYANOSIS / CLUBBING / LYMPHADENOPATHY / OEDEMA.
NO PALLOR/ ICTERUS / CYANOSIS / CLUBBING / LYMPHADENOPATHY / OEDEMA.
VITALS:
BP; 110/80MM HG
PR: 90 BPM
RR: 22 CPM
TEMP; 98F
SPO2: 98 @ RA
GEBS- 205 MG/ DL
BP; 110/80MM HG
PR: 90 BPM
RR: 22 CPM
TEMP; 98F
SPO2: 98 @ RA
GEBS- 205 MG/ DL
SYSTEMIC EXAMINATION:
CNS: NFND
REFLEXES:
B T S K A
R +2 +2 + 1 +2 +
L +2 +2 +1 +2 +
CVS:
S1, S2 HEARD, NO MURMURS
RS:
BAE +, NVBS
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P/A:
SOFT, NON-TENDER
CNS: NFND
REFLEXES:
B T S K A
R +2 +2 + 1 +2 +
L +2 +2 +1 +2 +
CVS:
S1, S2 HEARD, NO MURMURS
RS:
BAE +, NVBS
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P/A:
SOFT, NON-TENDER
COURSE IN THE HOSPITAL:
A 27 YR OLD MALE PATIENT CAME WITH C/O INVOLUNTARY
MOVEMENTS AND CONFUSION WITH GRBS OF 23 MG/DL AND WAS DIAGNOSED AS HYPOGLYCEMIC SEIZURES. PATIENT IS A K/C/O DM I AND SEIZURE DISORDER SINCE 15 YRS FOR SEIZURES HE USED ANTIEPILEPTICS FOR 3 YEARS AND STOPPED MEDICATION. FOR DM I HE WAS ON MIXTARD 20U-X-20U BD FOR GLYCEMIC CONTROL HE WAS PUT ON HAI TID
OPTHALMOLOGY OPINION WAS TAKEN AND PATIENT HAS DIABETIC RETINOPATHIC CHANGES [ MILD NPDR] PATIENT HAS HYPOTHYROIDISM SINCE 3 YRS WAS ON 100 MCG CHANGES TO 75 MCG BUT PATIENT HAD FLUCTUATING SUGARS AND. ENDOCRINE OPINION WAS TAKEN IN VIEW OF? BRITTLE DIABETES? HYPOPITUTARISM AND SIR HAS ADVICED INJ.LANTUS 8U AT NIGHT WITH 4U HAI TID BUT PATIENT HAS HYPOGLYCEMIA AT NIGHT.
OPTHALMOLOGY OPINION WAS TAKEN AND PATIENT HAS DIABETIC RETINOPATHIC CHANGES [ MILD NPDR] PATIENT HAS HYPOTHYROIDISM SINCE 3 YRS WAS ON 100 MCG CHANGES TO 75 MCG BUT PATIENT HAD FLUCTUATING SUGARS AND. ENDOCRINE OPINION WAS TAKEN IN VIEW OF? BRITTLE DIABETES? HYPOPITUTARISM AND SIR HAS ADVICED INJ.LANTUS 8U AT NIGHT WITH 4U HAI TID BUT PATIENT HAS HYPOGLYCEMIA AT NIGHT.
SO PT IS BEING Discharged UNDER OCTREOTIDE 100 MG STAT AND LOW DOSE
STEROID TO MAINTAIN EUGLYCEMIA
PATIENT IS BEING Discharged UNDER
HEMODYNAMICALLY STABLE CONDITION
Investigation
Name Value Range
Name Value Range
Name Value Range
COMPLETE URINE EXAMINATION (CUE) 10-06-2024 10:38:AM
COLOUR Pale yellow APPEARANCE Clear REACTION Acidic SP. GRAVITY 1.010 ALBUMIN +SUGAR Trace BILE
SALTS Nil BILE PIGMENTS Nil PUS CELLS 3-4 EPITHELIAL CELLS 2-3 RED BLOOD CELLS Nil CRYSTALS Nil CASTS Nil AMORPHOUS DEPOSITS Absent OTHERS Nil
HBsAg-RAPID 10-06-2024 10:38:AM Negative POST LUNCH BLOOD SUGAR 10-06-2024 10:40:AM
101 mg/dl 140-0 mg/dl
BLOOD UREA 10-06-2024 10:40:AM 25 mg/dl 42-12 mg/dl
HBsAg-RAPID 10-06-2024 10:38:AM Negative POST LUNCH BLOOD SUGAR 10-06-2024 10:40:AM
101 mg/dl 140-0 mg/dl
BLOOD UREA 10-06-2024 10:40:AM 25 mg/dl 42-12 mg/dl
SERUM CREATININE 10-06-2024 10:40:AM 1.4 mg/dl 1.3-0.9 mg/dl
SERUM ELECTROLYTES (Na, K, C l) 10-06-2024 10:40:AM SODIUM 141 mmol/L 145-136
mmol/L POTASSIUM 3.5 mmol/L 5.1-3.5 mmol/L CHLORIDE 104 mmol/L 98-107 mmol/L LIVER
FUNCTION TEST (LFT) 10-06-2024 10:40:AM Total Bilurubin 0.44 mg/dl 1-0 mg/dl Direct Bilurubin
0.14 mg/dl 0.2-0.0 mg/dl SGOT(AST) 30 IU/L 35-0 IU/LSGPT(ALT) 33 IU/L 45-0 IU/L ALKALINE
PHOSPHATASE 180 IU/L 128-53 IU/L TOTAL PROTEINS 6.4 gm/dl 8.3-6.4 gm/dl ALBUMIN 3.8
gm/dl 5.2-3.5 gm/dl A/G RATIO 1.48
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4
T3, T4, TSH 11-06-2024 05:50:AM T3 0.85 ng/ml 1.87-0.87 ng/ml T4 6.67 micro g/dl 12.23-6.32 micro
g/dl TSH 0.37 micro-Iu/ml 5.36-0.34 micro-Iu/ml peripheral SMEAR 11-06-2024 03:50:PM RBC:
Microcytic hypoochromic WBC: With in normal limits PLATELET: Adequate
STOOL FOR OCCULT BLOOD 11-06-2024 03:50:PM Negative (-ve)ABG 12-06-2024 07:40:AM PH
7.342 PCO2 33.8 PO2 73.3HCO3 17.8 St. HCO3 18.9 BEB -6.6BEecf -6.8TCO2 37.2O2 Sat 94.3O2
Count 14.1
SERUM CREATININE 12-06-2024 10:41:PM 1.6 mg/dl 1.3-0.9 mg/dl SERUM ELECTROLYTES (Na,
K, C l) 12-06-2024 10:41:PM SODIUM 136 mmol/L 145-136 mmol/L POTASSIUM 3.8 mmol/L 5.1-3.5
mmol/L CHLORIDE 102 mmol/L 98-107 mmol/L
PHOSPHOROUS 3.0 mg/dl 4.5-2.5 mg/dl
FBS: 287 MG/DL
PLBS: 101 MG/DL
HBA1C 8.2%
SERUM ELECTROLYTES (Na, K, C l) 10-06-2024 10:40:AM SODIUM 141 mmol/L 145-136
mmol/L POTASSIUM 3.5 mmol/L 5.1-3.5 mmol/L CHLORIDE 104 mmol/L 98-107 mmol/L LIVER
FUNCTION TEST (LFT) 10-06-2024 10:40:AM Total Bilurubin 0.44 mg/dl 1-0 mg/dl Direct Bilurubin
0.14 mg/dl 0.2-0.0 mg/dl SGOT(AST) 30 IU/L 35-0 IU/LSGPT(ALT) 33 IU/L 45-0 IU/L ALKALINE
PHOSPHATASE 180 IU/L 128-53 IU/L TOTAL PROTEINS 6.4 gm/dl 8.3-6.4 gm/dl ALBUMIN 3.8
gm/dl 5.2-3.5 gm/dl A/G RATIO 1.48
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4
T3, T4, TSH 11-06-2024 05:50:AM T3 0.85 ng/ml 1.87-0.87 ng/ml T4 6.67 micro g/dl 12.23-6.32 micro
g/dl TSH 0.37 micro-Iu/ml 5.36-0.34 micro-Iu/ml peripheral SMEAR 11-06-2024 03:50:PM RBC:
Microcytic hypoochromic WBC: With in normal limits PLATELET: Adequate
STOOL FOR OCCULT BLOOD 11-06-2024 03:50:PM Negative (-ve)ABG 12-06-2024 07:40:AM PH
7.342 PCO2 33.8 PO2 73.3HCO3 17.8 St. HCO3 18.9 BEB -6.6BEecf -6.8TCO2 37.2O2 Sat 94.3O2
Count 14.1
SERUM CREATININE 12-06-2024 10:41:PM 1.6 mg/dl 1.3-0.9 mg/dl SERUM ELECTROLYTES (Na,
K, C l) 12-06-2024 10:41:PM SODIUM 136 mmol/L 145-136 mmol/L POTASSIUM 3.8 mmol/L 5.1-3.5
mmol/L CHLORIDE 102 mmol/L 98-107 mmol/L
PHOSPHOROUS 3.0 mg/dl 4.5-2.5 mg/dl
FBS: 287 MG/DL
PLBS: 101 MG/DL
HBA1C 8.2%
Treatment Given (Enter only Generic Name)
INJ.LEVITIRECETAM 1GM IV/OD
INJ. GLARGINE SC/OD 8 UNITS 8 PM
INJ.HAI SC/TID ACCORDING TO GRBS
INJ.OCTREOTIDE 100 MG IV/ STAT
TAB.THYRONORM 100 MICRO GRAMS PO/OD
Advice at Discharge
INJ.GLARGINE S/C OD [8 UNITS]
TAB.LEVITIRACETAM 500 MG PO/OD
TAB. THYRONORM 75 MCG PO/OD 1-0-0 8 AM
INJ.HAI S/C TID [6-6-6]
TAB. DEFOCORT 6 MG 0-1-0 2PM
Follow Up
INJ. GLARGINE SC/OD 8 UNITS 8 PM
INJ.HAI SC/TID ACCORDING TO GRBS
INJ.OCTREOTIDE 100 MG IV/ STAT
TAB.THYRONORM 100 MICRO GRAMS PO/OD
Advice at Discharge
INJ.GLARGINE S/C OD [8 UNITS]
TAB.LEVITIRACETAM 500 MG PO/OD
TAB. THYRONORM 75 MCG PO/OD 1-0-0 8 AM
INJ.HAI S/C TID [6-6-6]
TAB. DEFOCORT 6 MG 0-1-0 2PM
Follow Up
REVIEW TO GENERAL MEDICINE OPD AFTER 2 WEEKS ON MONDAYS.
When to Obtain Urgent Care
IN CASE OF ANY EMERGENCY IMMEDIATELY CONTACT YOUR CONSULTANT DOCTOR OR
ATTEND EMERGENCY DEPARTMENT.
Preventive Care
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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: hospital phone helpline For Treatment Enquiries Patient/Attendant 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:15/6/24
Ward: AMC
Unit: I
IN CASE OF ANY EMERGENCY IMMEDIATELY CONTACT YOUR CONSULTANT DOCTOR OR
ATTEND EMERGENCY DEPARTMENT.
Preventive Care
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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: hospital phone helpline For Treatment Enquiries Patient/Attendant 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:15/6/24
Ward: AMC
Unit: I
[04-11-2024 21:12] PPM 3: Meeku government iche insulin dose adjust cheyali ante kodhi rojulu meeru
Fasting blood sugar (padigadupuna)
Breakfast tarvatha Rendu gantalaki
Lunch Tarvatha Rendu gantalaki
Dinner Tarvatha Rendu gantalaki
Sugars check chesukuni maku Ikkada chepthe memu dose adjust chestam
[04-11-2024 21:16] PA: Meter Panicheyatledu sir
[05-11-2024 06:46] PPM 1: @PPM3 he's giving us a lot of points regarding the tech resource challenges to speak about on November 28!
[23-12-2024 11:19] PPM 1: 👆Did you get an opportunity to talk to this most erratic patient in our PaJR? Suddenly out of the blue he puts forward a local requirement without meeting any of our requirements of hyperlocal information continuity!
If we can buy in a better provider patient relationship in such challenging patients we will be considerably moving forward to scaling our service delivery mechanisms @PPM2
[23-12-2024 11:30] PA: Use cheyocha sir
[23-12-2024 20:10] PPM 1: Any insights as to why he's so erratic in his sharing and why he doesn't make it easy for us to try and help him?
[23-12-2024 20:22] PPM 1: Okay!
[23-12-2024 20:38] PA: Morning 15 units Insulin
2 chapathi
Afternoon Rice ladies finger curry
Night Rice amla pickle
[23-12-2024 21:41] PPM 2: Because the burden of data sharing is on the advocate. We need a sensor asap
[24-12-2024 09:25] PPM 1: Well captured
If only we could capture patient data in a more seamless manner!
[29-12-2024 12.26] PA: Good afternoon sir, lunch rice with cauliflower
[29-12-2024 16:14] PPM 1: @CR he seems to be making amends
However can we hope for him ever to share his insulin doses and blood sugar outcomes even once a week for the fasting and three 2 hour post meals sugars?
[06-06-2025 13:26] PA: Good Afternoon Sir
[06-06-2025 16:20] PPM 1: He seems to have returned 6 months later!
[07-06-2025 20:21] PA: Yes Sir
[08-06-2025 07:45] PA: Human mixtard insulin 16
[08-06-2025 10:17] PPM 1: Fasting blood sugar?
Also please let us know the blood sugar after two hours of this mixtard 16 and also two hours after lunch and dinner.
@CR @PPM4 @PPM2 we may need to talk with this patient who's otherwise quite experienced with his diabetes but has an erratic patient advocate when it comes to actual sharing his data
[08-06-2025 12:34] CR: Spoke to him.
[14-06-2025 12:22] PA: Morning insulin human mixtard 15 units.
[14-06-2025 12:23] PA: Tiffen dosa
[14-06-2025 12:29] PA: After 2 hours test 91mg/dl
[16-06-2025 11:42] PA: Morning 15 units insulin Rice 2 hours test 170
[16-06-2025 21:33] PPM 1: How many times is this patient taking mixtard?
What about his night dose?
[16-06-2025 21:36] PA: 2 hours after test sir
[16-06-2025 21:52] PPM 1: Morning 15U
Evening?
[17-06-2025 06:43] PA: 8 units mixtard sir day by day
[17-06-2025 07:08] PPM 1: So everyday
15U mixtard in the morning
And
8U mixtard in the evening?
[17-06-2025 07:25] PA: Yes sir
[17-08-2025 10:07] PPM 1: Patient ippudu enni rol ninchi em insulin use chestunnaru?
@CR is there any updated version of his PaJR case report?
[17-08-2025 10:41] CR: I will do it today
[17-08-2025 10:56] CR: We couldn't find his consent form in the e mail. That's why no case report I guess.
[17-08-2025 12:35] PPM 1: Alright.
@PPM5 can you get him to download the consent form and sign with full address, age, gender, complaints, date and rescan it and send?
[17-08-2025 12:53] PPM 1: Yes it's the same
[17-08-2025 12:55] PA: Okay Sir
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