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.
[13-08-2025 15.12] PPM 1: IP now: 92F with trunkal obesity driven metabolic syn and Diabetes since she was 82! Currently admitted with lower limb cellulitis and heart failure.
10/08/25 👇
10/08/25 👇
11/08/25 👇
13/08/25 👇
14/08/25 👇
PPM 1: Worsening of pulmonary edema on 14 other than the rotation
[14-08-2025 16.46] PPM 1: Afternoon session update from her 50M son who is already a diabetic since 10 years with sarcopenia and trunkal obesity which he claims to sport since he was 20!He says his mother is 94 not 92
Her husband, his father died at the age of 94 in the year 1990 and had no trunkal obesity, used to cycle 20 kms daily at the age of 90! He died of a mysterious illness that started with chills and fever that continued for 5 years before he died. The current 94F patient, his wife, was the sole caregiver at that time as children were away.
94F developed her trunkal obesity at the age of 30 and first developed diabetes at the age of 80! Her son developed trunkal obesity at 20 and diabetes 40! None of his 5 elder sisters have trunkal obesity or diabetes (sisters got father's genes?).
[14-08-2025 17:01] PPM 2: Very insightful but we are still unsure if she was on steroids - which as we all know is rampant in rural India.
[14-08-2025 17:18] PPM 2: We saw one such patient in the OPD today! @PPM3 can you update?
[16-08-2025 19:55] PPM 1: Update @PPM4 @PPM5
[16-08-2025 20:07] PA: Patient status sir
[16-08-2025 22:01] PPM 5: Sir patient saturation is maintaining had tachypnea and bicarb retension sir
[16-08-2025 22:01] PPM 5: Bp and pulse were normal sir
[17-08-2025 07:03] PPM 1: Still on T piece?
Sensorium?
Serial ABGs?
[17-08-2025 07:11] PPM 5: Sir not on T piece
2lit o2 she is maintaining
GCS: E3v4m5
PPM 1: 👍
[18-08-2025 14.58] PPM 1: Update.
EMR summary:
Age/Gender: 94 Years/Female
Address:
Discharge Type: Relieved
Admission Date: 10/08/2025 10:00 AM
Diagnosis
Right LOWER LIMB CELLULITIS WITH SEPSIS WITH HYPOGLYCEMIA (RESOLVED)
NEUROGLYCOPENIA
WITH HYPERTENSIVE EMERGENCY WITH PULMONARY EDEMA
WITH TYPR -I RESPIRATORY FAILURE
K/C/O T2DM SINCE 10 YEARS
S/P EXTUBATION DAY 4
Case History and Clinical Findings
PT CAME TO CASUALITY IN UNRESPONSIVE STATE AND SINCE MORNING (10/8/25)
HOPI PATIENT PRESENTED IN UNCONSCIOUS STATE AND WAS IN RESPIRATORY DISTRESS
WITH H/O ULCER OVER THE RT FOOT WITH SWELLING OF RT LOWER LIMB
PT 0N 9/8/25, AFTERNOON DEVELOPED AN EPISODE OF HYPOGLYCEMIA AND WAS
UNCONSCIOUS, RESOLVED AFTER CONNECTING 25D OUTSIDE
C/O FEVER 2 DAYS AGO, INSIDIOUS IN ONSET AND LOW GRADE, RELIEVED ON
MEDICATION.
C/O B/L MILD PEDAL EDEMA, PITTING TYPE
NO C/O CHEST PAIN, PALPITATIONS, HEADCHE, BLURRING OF VISION, NAUSEA, VOMITING
NO H/O DECREASED URINE OUTPUT, BOWEL OR BLADDER INCONTINENCE
NO H/O INVOLUNTARY MOVEMENTS OF LIMBS, UPROLLING OF EYES, DROOLING OF SALIVA
PAST HISTROY
K/C/O TYPE 2 DM SINCE 10 YEARS ON TAB GLIMI M1 1/2-1-0
Page-2
KIMS HOSPITALS
H/O RESPIRATORY COMPLAINTS (SOB, COUGH) 3 MONTHS AGO, GOT ADMITTED AT
OUTSIDE HOSPITAL.
DIAGNOSED WITH HTN 5DAYS AGO, NOT STARTED TO TAKE MEDICATION
N/K/C/O CAD, CVA, THYROID, TB, EPILEPSY, ASTHMA
PERSONAL HISTORY: MARRIED, MIXED DIET, REGULAR BOWEL AND BLADDER MOVEMENTS, NO KNOWN ALLERGIES
ADDICTIONS: OCCASIONAL ALCOHOL DRINKING
FAMILY HISTORY - NOT SIGNIFICANT
GENERAL EXAMINATION: PALLOR PRESENT,EDEMA OF FEET PRESENT
NO ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY,MALNUTRITION
VITALS:- TEMP: 98.0 F, BP: 190/100MMHG, RR: 28CPM, PR: 100 BPM, SPO2:98% WITH 4 L OF
O2, GRBS -19MG/DL
SYSTEMIC EXAMINATION :
CVS - S1 S2 +, NO MURMURS
RS - BAE +, NVBS
PER ABDOMEN - SOFT , DISTENDED,MILD
CNS - GCS:E1V1M1
PUPILS- NSRL
RIGHT LOWER LIMB REDNESS PRESENT
COURSE IN THE HOSPITAL-
92 YR OLD FEMALE WITH H/O ULCER OVER THE RT FOOT AND PREVIOUS H/O
HOSPITALISATION I/V/O RESPIRATORY DISTRESS CAME TO CASUALITY IN THE STATE OF
UNRESPONSIVENESS AND RSPIRATORY DISTRESS SINCE MORNING WITH GRBS-19MG/DL AND WAS IMMEDIATELY CONNECTED TO 25% D, PT GAINED CONSCIOUSNESS WITH GRBS-121 AND GCS-E4V1M1 WITH ABG PH- 7.325, PCO2-45.8, PO2-179, HCO3--23.2 AND WAS INTUBATED I/V/O RESPIRATORY DISTRESS AND POOR GCS.MRI BRAIN AND HRCT CHEST
WAS DONE.NECESSARY INVESTIGATIONS AND BLOOD URINE CULTURES WERE SENT AND PT WAS STARTED ON ANTIBIOTICS AND SUPPORTIVE MANAGEMENT.CENTRAL LINE WAS PLACED, VENTILATOR CARE WAS GIVEN AND STARTED ON RT FEEDS. REGULAR DRESSINGS WERE DONE FOR ULCER OVER THE RT FOOT. PT GCS STARTED TO IMPROVE AND VENTILATOR MODE WAS CHANGED FROM ACMV TO SIMV MODE AND ET CULTURES WERE SENT.ON DAY 4 WEAN OFF CRITERIA WAS MET AND THE PT WAS EXTUBATED. BP RECORDING WERE HIGH, STARTED ON ANTIHYPERTENSIVES AND CONTINUED ON OXYGEN SUPPORT. PATIENT IS MAINTAINING WELL ON OXYGEN SUPPORT AND IS BEING DISCHARGED IN HEMODYNMICALLY STABLE STATE.
Page-3
KIMS HOSPITALS
Investigation
Blood Lactate 15.0 mg/dl ON 10/8/25
HbA1c 6.8 % ON 10/8/25
D DIMER ON 10/8/25 2320 NG/ML
APTT ON 10/8/25 32SECONDS, PT- 16SEC, INR-1.1 SEC
CUE ON 10/8/25 ALBUMIN-+30MG/DL BILE SALTS -NIL BILE PIGMENTS-NIL PUS CELLS-3 -4, RBC -NIL CASTS-NIL
LFT ON 10/8/25 Total Bilurubin 0.60 mg/dl Direct Bilurubin 0.17 mg/dl SGOT(AST) 22 IU/L
SGPT(ALT) 16 IU/L ALKALINE PHOSPHATASE-126 IU/L TOTAL PROTEINS 5.9 gm/dl ALBUMIN 3.6 gm/dl A/G RATIO 1.58
RFT ON 10/8/25 UREA 42 mg/dl CREATININE 0.8 mg/dl URIC ACID 2.7 mmol/L CALCIUM 9.4
mg/dl PHOSPHOROUS 2.0 mg/dl SODIUM 134 mmol/L POTASSIUM 4.0 mmol/L CHLORIDE 95
mmol/L ->RFT ON 13/8/25 UREA 34 mg/dl CREATININE 0.7 mg/dl URIC ACID 1.7 mmol/L
CALCIUM 9.4 mg/dl PHOSPHOROUS 2.47 mg/dl SODIUM 132 mmol/L POTASSIUM 3.2 mmol/L
CHLORIDE 94 mmol/L
SERUM ELECTOLYTES 11/8/25 SODIUM 144 mmol/L POTASSIUM 3.4 mmol/L CHLORIDE 98
mmol/L -> 14/8/25 SODIUM 136 mmol/L POTASSIUM 3.2 mmol/L CHLORIDE 98 mmol/L -> 16/8/25
SODIUM 140 mmol/L POTASSIUM 3.8 mmol/L CHLORIDE 99 mmol/L
HEMOGRAM 10/8/25 HEMOGLOBIN-10.2GM/DL TLC-12940CELLS/CUMM RBC COUNT - 3.4
MILLION/CUMM PCV-29.2% PLATLETES-2.1 LAKH/CUMM
HEMOGRAM 11/8/25 HEMOGLOBIN-9.1GM/DL TLC-10700CELLS/CUMM RBC COUNT - 3.0
MILLION/CUMM PCV-29.2% PLATLETES-2.2 LAKH/CUMM
HEMOGRAM 12/8/25 HEMOGLOBIN-9.0GM/DL TLC-9400CELLS/CUMM RBC COUNT - 3.06
MILLION/CUMM PCV-29.2% PLATLETES-2.11 LAKH/CUMM
HEMOGRAM 13/8/25 HEMOGLOBIN-10.2GM/DL TLC-12940CELLS/CUMM RBC COUNT - 3.4
MILLION/CUMM PCV-29.2% PLATLETES-2.1 LAKH/CUMM
HEMOGRAM 14/8/25 HEMOGLOBIN-9.7GM/DL TLC-10900CELLS/CUMM RBC COUNT - 3.38
MILLION/CUMM PCV-29.2% PLATLETES-2.43 LAKH/CUMM
HEMOGRAM 15/8/25 HEMOGLOBIN-9.3GM/DL TLC-8900CELLS/CUMM RBC COUNT - 3.14
MILLION/CUMM PCV-29.2% PLATLETES-2.8 LAKH/CUMM
HEMOGRAM 16/8/25 HEMOGLOBIN-9.6GM/DL TLC-10000CELLS/CUMM RBC COUNT - 3.25
MILLION/CUMM PCV-29.2% PLATLETES-3.25 LAKH/CUMM
HEMOGRAM 17/8/25 HEMOGLOBIN-10.3GM/DL TLC-12100CELLS/CUMM RBC COUNT - 3.5
MILLION/CUMM PCV-32.4% PLATLETES-3.5 LAKH/CUMM
HEMOGRAM 18/8/25 HEMOGLOBIN-9.6GM/DL TLC-10000CELLS/CUMM RBC COUNT - 3.25
MILLION/CUMM PCV-29.2% PLATLETES-3.25 LAKH/CUMM
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KIMS HOSPITALS
ABG - 10/08/25PH-7.325PO2-179PCO2-45.8 HCO3-23.5; PH-7.25 PO2-128 PCO2-55.5 HCO3-23.5
-> ABG - 11/08/25 PH-7.32 PO2-225 PCO2-40.1 HCO3-20.3 -> ABG - 12/08/25 PH-7.4 PO2-152
PCO2-51.9 HCO3-31.5 -> ABG - 13/08/25 PH-7.414 PO2 -140 PCO2-49.9 HCO3-31.3-> ABG -
14/08/25 PH-7.4 PO2-32.5 PCO2-61.1 HCO3-37 -> ABG - 15/08/25 PH-7.328 PO2-79.1 PCO2-64.8
HCO3-33 -> ABG - 16/08/25 PH-7.325 PO2-72.9 PCO2-71.4 HCO3-36.2->ABG-17/8/25 PH-7.36
,PO2-96.3 ,PCO2-46.4,HCO3-25.4->ABG-18/8/25 PH-7.324 PO2-88.2 PCO2-53.7 HCO3-25.4
MRI BRAIN ON 10/8/25 - NORMAL STUDY
HRCT CHEST - RIGHT LUNG BASAL ATELECTASIS, DIALTED LEFT CARDIAC CHAMBER,
CASEOUS CALCIFICATION OF MITRAL VALVE APPARATUS
ULTRASOUND ON 10/8/25-S/O FREE FLUID NOTED IN PERICARDIAL SPACE,MILD
PERICARDIAL EFFUSION
XRAY CHEST 11/8/25 - RIGHT LUNG BASAL COLLAPSE WITH RIGHT LOWER ZONE FIBROSIS;
B/L RETICULAR OPACITIES IN BOTH LUNGS (RT>LF)
BLOOD CULTURE DONE 10/8/25 -NO BACTERIAL GROWTH
URINE CULTURE DONE 10/8/25-NO BACTERIAL GROWTH
SWAB CULTURE DONE ON 10/8/25-PSEUDOMONAS AEROGINOSA SEEN,SENSITIVE TO
ANTIBIOTICS
ET SECRETIONS CULTURE DONE ON 11/8/25-NO BACTERIAL GROWTH
ET SECRETIONS CBNAAT - NEGATIVE
MRI BRAIN ON 18/8/25 - NO ABNORMALITY IN MRI BRAIN
Treatment Given (Enter only Generic Name)
RT FEEDS 2ND HOURLY WATER 50 ML,4TH HRLY MILK 100 ML
IVF NS/RL 50 ML/HR
INJ PIPTAZ 4.5 ML IV/TID FOR 7 DAYS
INJ METRONIDAZOLE 500 MG IV/TID FOR 7 DAYS
INJ PAN 40MG IV/OD
INJ HYDROCORT 100 MG IV SOS
SYP POTKLOR 20ML /TID FOR 1 DAY
TAB AMLO 5MGRT/OD
NEB DUOLIN ,BUDECORT,MUCOMIST EVERY 4 HRLY
CHEST PHYSIOTHERAPY 2ND HRLY
Advice at Discharge
INTERMITTENT O2 SUPPORT 2LIT/MIN
INTERMITTENT BIPAP SUPPORT
RT FEEDS 2ND HOURLY WATER 50 ML,4TH HRLY MILK 100 ML
Page-5
KIMS HOSPITALS
TAB. PANTOP 40MG PO/OD 1-0-0 X 7 DAYS
TAB CEFPEROXIME 200MG PO/BD X 7 DAYS 1-0-1
TAB CLINDAMYCIN 600MG PO/BD X 7 DAYS 1-0-1
TAB AMLONG 5MG PO/OD X TO CONTINUE 1-0-0
TAB. CHYMOROL FORTE PO/BD FOR 7 DAYS 1-0-1
TAB. PULMOCLEAR PO/BD 1-0-1 FOR 7 DAYS
NEB DUOLIN ,BUDECORT,MUCOMIST EVERY 8 HRLY
CHEST PHYSIOTHERAPY 2ND HRLY
NEOSPORIN POWDER FOR L/A
AIR BED
Follow Up
REVIEW TO GM OP AFTER 1WEEK/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/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:18/8/25
Ward: ICU
Unit: 3
[20-08-2025 23.40] PPM 2: Hopefully Hypothyroidism ruled out? Sorry can't glean out numbers
[21-08-2025 07.13] PPM 1: @PPM6 @ppm5 can you confirm if a thyroid function test was done in this patient? Unable to see it in the EMR summary above
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