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 COLLECTIVE CURRENT BEST EVIDENCE BASD INPUTS.
[07-10-2025 21.59] PPM 3: Can anyone give a short history of the case?
[07-10-2025 21.59] PPM 1: It's given in the NKP group
45M diagnosed diabetes on June 2025
Lean phenotype without trunkal obesity
Was initially evaluated in ESI hospital Choutuppal and started on glimiperide, metformin, sitagliptin and later even mixtard insulin was added.
Currently admitted due to altered sensorium and some vague history of hypoglycemia two days back with MRI showing csvd in the pons.
His son 24M was diagnosed diabetes and is on insulin mixtard twice a day since October 2024!
@pajr.in CEO, NHS Endocrinologist this is also one of the patients who's Hba1c has been documented to break the Narketpally turbilatex ceiling of 8 with a value of 9! There's another one @PPM4 knows had 10 and there's another one with 13 admitted today! Suddenly a breakthrough cluster in our NKP Hba1c!
[07-10-2025 22.06] PPM 3: Has his sensorium improved since admission?
[07-10-2025 22.20] PPM1: No
[07-10-2025 23.50] PPM 2: Thanks for sharing sir. What is the current working diagnosis and what is being treated?
[08-10-2025 08.53] PPM 1: Working differential diagnosis for his altered sensorium is:
1) Post hypoglycemia brain injury
2) Brain vascular injury
Management of altered sensorium is conservative observation
[08-10-2025 10.23] PPM 2: How bad was the hypo? Was the patient unaware of the hypo?
Any suggestive history of hypo unawareness in the past
[08-10-2025 10.31] PPM 5: We are not really sure if it was hypo, patient attender gave history of patient becoming unresponsive, after which they fed him sugar water, and he improved little, then they took him to a nearby hospital.
[08-10-2025 10.36] PPM 2: Thanks. Did something like this happen before? Thanks. Did something like this happen before?
[08-10-2025 13.09] PPM 1: Hypo was the 24 year son's hypothesis who himself has diabetes on insulin since October 2024!
He gave sugar water but wasn't convinced with the outcome and rushed him to a local doctor before eventually bringing him here.
He totally recovered his sensorium yesterday at 7:00PM!
Any thoughts on iv lacosamide administered since last 2 days and citicholine administered today after he woke up (because it was procured late). Perhaps both these drugs may not be able to survive a UK NHS style of clinical audit if performed to the letter here? @PPM2
[08-10-2025 15.23] PPM 2: Citicholine is not available. Interesting choice with Lacosamide
[08-10-2025 15.42] PPM 4: Both lacosamide and citicholine was started since yesterday sir
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