63M Diabetes 20 years, pruritus and skin lesions months WB PaJR
10/12/24
PaJR PHR Moderator: 59M grbs-long distance patient
8 pm-318
10 pm-251
2am-255
7am-295
👆Uni sugarer oshudh koto dose ebong ki time a khacchen ektu janaben
Sokaler Vildagliptin ta bondho kore Otao tablet glimiperide 2mg kore din
MOPD
Met this patient once in 2014 and 2015 in Bhopal @Participant and once in 2016 in Durgapur @Participant
Diabetes since 2013
Currently on OHAs GP2 once and sitagliptin 50 once daily
Complains of increased frequency of urination 6 months only in morning. No nocturia. Also complains of Hematuria once one month back.
Pruritus at the back and lower limbs 2 months.
@Paticipant @Participant we have admitted him in SS ward
Please get his urine CUE, culture, seven point sugar profile, chest X-ray, ECG, LFT, RFT, Hemogram, Ultrasound and urology opinion
Paticipant: Sir medicine dose
Glmeprid 2mg one+1mg1/2 two' time before meal
Metformine TDS one tab after meal
That's right sir please reply
PaJR PHR Moderator: Right
Glimiperide 2.5 before meals
@Participant please share his dermatology notes
PaJR PHR Moderator: @Narmeen Shah I shall get the signed informed consent from them tomorrow in the OPD and then if you have the time you can begin the case report
Narmeen Shah: Sure sir no problem 🍁
PaJR PHR Moderator: @Participant @Participant his Hba1c appears to 8 which @Participant is pretty high by our lab standards as anecdotally the highest Hba1c recorded (although remains unarchived) is 8.5!
@Participant please share his sugar profile since admission
His ultrasound report
Participant:
Participant: 09/12
10pm-251
2am-255
7am-295
Participant: 10/12
10am 405
1pm 315
4pm 450
8pm 373
10pm-276
2am-194
7am - 192
PaJR PHR Moderator: Did he take glimiperide 2.5mg before lunch yesterday?
When is he taking his glimiperide 2.5 mg today?
Urine CUE report and urine culture?
Participant:
PaJR PHR Moderator: And the urine culture will take time? How about doing a urine 24 hour protein and creatinine now?
Participant: Ok sir
Yes sir urine culture reports are yet to come
Participant: Yes sir I take this medicine
PaJR PHR Moderator: Also please share the three discharges.
They are all three planned to be discharged in the morning tomorrow as they have a train to catch @Participant
PaJR PHR Moderator: This patient's EMR summary
Diagnosis
K/C/O DM II SINCE 20 YEARS
Case History and Clinical Findings
C/O POLYURIA SINCE 6 MONTHS
HOPI:
PATIENT WAS APPARENTLY Asymptomatic 6 MONTHS AGO AFTER WHICH HE
DEVELOPED INCREASED FREQUENCY OF URINE ONLY IN MORNING, INSIDIOUS IN ONSET ,
GRADUALLY PROGRESSIVE. NO Aggravating AND Relieving FACTORS.
H/O HEMATURIA ONCE A MONTH BACK
H/O PRURITIS AT THE BACK AND LOWER LIMBS SINCE 2 MONTHS
NO C/O SOB, CHEST PAIN, CHEST TIGHTNESS
NO C/O NOCTURIA, POLYPHAGIA, POLYDIPSIA
NO C/O NUMBNESS AND TINGLING SENSATION OF BOTH HANDS AND LEGS
PAST HISTORY
K/C/O DIABETES MELLLITUS- 2 SINCE 20 YEARS AND ON MEDICATION (TAB.
VIDAGLIPTION/METFORMIN - 50/500MG, TAB GLIMIPERIDE 2MG) PO/HS
N/K/C/O HYPERTENSION ,CAD,CVA,SEIZURES,TB,THYROID DISORDERS
ADDICTIONS :
TOBACCO SINCE 15 YEARS 4-5 DAILY (CIGARETTES)
GENERAL EXAMINATION :
PATIENT IS C/C/C
NO PALLOR, ICTERUS, CYANOSIS, CLUBBING, LYMPHEDENOPATHY, EDEMA
BP: 130/80 MMHG
PR: 82 BPM
RR: 18 CPM
SPO2: 99%
GRBS:160 MG/DL
SYSTEMIC EXAMINATION :
CVS: S1S2 +
RS: BLAE + NVBS HEARD
P/A:SOFT,NON TENDER
CNS: NFND
DERMATOLOGY REFERRAL WAS DONE ON 10/12/24 I/V/O PRURITIS OVER BACK AND
LOWER LIMBS SINCE 2 MONTHS
DIAGNOSIS: PRURITIS UNDER EVALUATION
TREATMENT: 1. LIQUID PARAFFIN L/A BD FOR 2 WEEKS
2. TAB. TECZINE 5MG PO/OD FOR 7 DAYS
UROLOGY REFERRAL WAS DONE ON 10/12/24 I/V/O INCREASED MICTURITION
TREATMENT: TAB. DOXYCYCLINE 400MG FOR 1 WEEK
CONTROL BLOOD SUGARS
ADVISE: REVIEW AFTER HBA1C REPORT
COURSE IN THE HOSPITAL:
PATIENT WAS ADMITTED I/V/O ABOVE SAID COMPLAINTS AND ON FURTHER EVALUATION
PATIENT WAS DIAGNOSED AS K/C/O DM TYPE 2 SINCE 20 YEARS .PATIENT WAS MANAGED
CONSERVATIVELY WITH TAB. VIDAGLIPTION/METFORMIN - 50/500MG, TAB GLIMIPERIDE
2MG. PATIENT IMPROVED SYMPTOMATICALLY AND IS BEING DISCHARGE IN
HEMODYNAMICALLY STABLE CONDITION.
** Tentative Date Page-3
KIMS HOSPITALS,Narketpally
Nalgonda-T.S
3
Investigation
HEMOGRAM:
HAEMOGLOBIN 13.1 gm/dlTOTAL COUNT 7,700 cells/cummNEUTROPHILS 73 %LYMPHOCYTES
22 %EOSINOPHILS 01 %MONOCYTES 04 %BASOPHILS 00 %PCV 38.4 vol %M C V 81.5 flM C H
27.8 pgM C H C 34.1 %RDW-CV 14.0 %RDW-SD 42.8 flRBC COUNT 4.71 millions/cummPLATELET
COUNT 1.14 lakhs/cu.mm
COMPLETE URINE EXAMINATION (CUE) 09-12-2024 12:29:PMCOLOUR Pale
yellowAPPEARANCE ClearREACTION AcidicSP.GRAVITY 1.010ALBUMIN ++SUGAR +++BILE
SALTS NilBILE PIGMENTS NilPUS CELLS 3-4EPITHELIAL CELLS 2-3RED BLOOD CELLS
NilCRYSTALS NilCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS Nil
RFT 09-12-2024 12:29:PMUREA 44 mg/dl 50-17 mg/dlCREATININE 1.2 mg/dl 1.3-0.8 mg/dlURIC
ACID 4.3 mmol/L 7.2-3.5 mmol/LCALCIUM 9.8 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 2.6 mg/dl 4.5-
2.5 mg/dlSODIUM 137 mmol/L 145-136 mmol/LPOTASSIUM 4.4 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
105 mmol/L 98-107 mmol/L
LIVER FUNCTION TEST (LFT) 09-12-2024 12:29:PMTotal Bilurubin 0.83 mg/dl 1-0 mg/dlDirect
Bilurubin 0.19 mg/dl 0.2-0.0 mg/dlSGOT(AST) 21 IU/L 35-0 IU/LSGPT(ALT) 23 IU/L 45-0
IU/LALKALINE PHOSPHATASE 337 IU/L 119-56 IU/LTOTAL PROTEINS 6.8 gm/dl 8.3-6.4
gm/dlALBUMIN 3.96 gm/dl 4.6-3.2 gm/dlA/G RATIO 1.39
RBS - 440MG/DL
9-12-24 GRBS MONITORING
10 PM 251 MG/DL
2 AM 255 MG/DL
7 AM 295 MG/DL
10-12-24
10AM 405 MG/DL
1 PM 315MG/DL
4 PM 450MG/DL
8PM 373MG/DL
10PM 276MG/DL
2 AM 194MG/DL
7 AM 192MG/DL
11-12-24
10 AM 320MG/DL
ULTRASOUND:
** Tentative Date Page-4
KIMS HOSPITALS,Narketpally
Nalgonda-T.S
4
GRADE 1 PROSTATOMEGALY WITH MEDIAN LOBE HYPEERTROPHY
B/L RENAL CYSTS
Treatment Given(Enter only Generic Name)
TAB. VIDAGLIPTION/METFORMIN - 50/500MG PO/OD
TAB GLIMIPERIDE 2MG PO/OD AT 8PM
TAB. METFORMIN 50MG PO/TID
TAB GLIMIPERIDE 1 MG PO/OD AT 8 AM
TAB DOXYCYCLINE 5 MG PO/HS
TAB TECZINE 5MG PO/HD AT 7 AM
LIQUID PARAFFIN L/A /BD
Advice at Discharge
TAB. VIDAGLIPTION/METFORMIN - 50/500MG PO/OD TO CONTINUE
TAB GLIMIPERIDE 2MG PO/OD AT 8PMTO CONTINUE
TAB. METFORMIN 50MG PO/TIDTO CONTINUE
TAB GLIMIPERIDE 1 MG PO/OD AT 8 AMTO CONTINUE
TAB TECZINE 5MG PO/HD AT 7 AM X 5DAYS
LIQUID PARAFFIN L/A /BD X 1WEEK
Follow Up
REVIEW TO GM OPD AFTER 2 WEEKS /SOS
Okay sir I informed respective unit Pgs
They would be sharing it with you at earliest time possible
Participant: Okay sir I informed respective unit Pgs
They would be sharing it with you at earliest time possible
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