30F DM1 8yrs, CKD 3yrs, COMA 20days Telangana PaJR

 

27-10-2025

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.

[5.11 pm, 27/10/2025] PPM 1: She lost this thumb recently of gangrene possibly due to iatrogenic reasons right after a venous cannulation around the thumb. 

@PPM3 @PPM4 @PPM5 please share the rest of her history details as I forgot to image the handwritten notes

[6.48 am, 28/10/2025] PPM 1: MRI Brain of this patient 👇
https://youtube.com/shorts/Qd03jdVZWAg?si=HMzz1Ot0KB57pjw7

[4.22 pm, 31/10/2025] PPM 1: @PPM5 @PPM6 can you share her history a bit?

We know that she had diabetes detected during gestation 8 years back, husband left her soon after and she took on the added tag of a single mother managing child and diabetes that was thought to be insulin dependent and three years back she also developed renal failure and severe secondary hypertension ever since she began dialysis a year back. This time she came with hypertensive LVF followed by altered sensorium possibly due to uremic encephalopathy that was also managed as meningitis by the local team inspite of no CSF evidence of meningitis.

She was intubated for altered sensorium last week and was extubated yesterday.

She lost this thumb recently of gangrene possibly due to iatrogenic reasons right after a venous cannulation around the thumb. 

@PPM3 @PPM4@PPM5 please share the rest of her history details as I forgot to image the handwritten notes.

@PPM6 please share her previous EMR summary IP number so that I can get the data from staff.

[4.29 pm, 31/10/2025] PPM 1:

[11.24 am, 01/11/2025] PPM 5: Patient was first diagnosed with diabetes during her first pregnancy (3rd month) in 2017 and was started on insulin. she had recurrent hypoglycemia and visited multiple hospitals for the same and insulin dose was reduced. Then she developed hypertension in 2021, in 2023 she had pedal edema, facial puffiness and decreased urine output and consulted nephrologist and was diagnosed as diabetic Nephropathy started on medical management. In 2025 January she had pulmonary edema and was started on dialysis since then. 5 months ago she came for maintence hemodialysis and had fever for which cannula was placed in left wrist region which had swelling followed which gangrene of left thumb (1st distal phalanx) developed and self amputated after 1 month. Now she came for main stance hemodialysis after which she developed severe abdominal pain with vomitings. Next day she was in altered sensorium and low gcs for which she was intubated and extubated 2 days ago.
[1.09 pm, 01/11/2025] PPM 2: How and why was she diagnosed with Type 1 Diabetes?