IMMEDIATE CAUSE TYPE 1 RESPIRATORY FAILURE ANTECEDANT CAUSE ALTERED SENSORIUM SECONDARY TO METABOLIC ENCEPHALOPATHY [RECURRENT HYPOGLYCEMIA / HYPOXIA ] IMPENDING DESCENDING HERNIATION

 Case History and Clinical Findings

CHIEF COMPLAINTS ; PATIENT CAME WITH COMPLAINTS OF BEING UNRESPONSIVE SINCE 2 HOURS [6.00 AM]

HOPI ; PATIENT WAS APPARENTLY ALRIGHT AT 6.00 AM WAS ABLE TO DO HER ROUTINE DAILY ACTIVITIES FOLLOWING WHICH SHE WAS FOUND UNRESPONSIVE AND NO C/O INVOLUNTARY MOVEMENTS ,INVOLUNTARY MICTURITION ,DEFECATION,UPROLLING OF EYES , TONGUE BITE

PATIENT WAS TAKEN TO AREA HOSPITAL .GRBS WAS 32MG/DL SPO2 80% ON KA CONSERVATIVE WAS GIVEN [BLOOD GLUCOSE LEVELS WERE CORRECTED ,O2 INHALATION SUPPLEMENTATION INJ DERIPHYLLINE WAS GIVEN AND WAS SENT TO OUR HOSPITAL FOR FURTHER MANAGEMENT

HISORY OF PAST ILLNESS ; NO H/O SIMILAR COMPLAINTS IN THE PAST NO C/O FEVER ,VOMITING,LOOSE STOOLS,PAIN ABDOMEN ,SOB ,CHESTPAIN , PALIPITATIONS

PATIENT ATTENDARS GAVE HISTORY THAT PATIENT CONSUMED 6-8 TABLETS OF GLIMPIRIDE

N/K/C/O HTN ,DM , CVA ,CAD ,TB, ASTHMA

GENERAL EXAMINATION;

GENERAL EXAMINATION

PATIENT IS CONSCIOUS

NO PALLOR ,ICTERUS, CYANOSIS ,CLUBBING ,LYMPHADENOPATHY ,OEDEMA OF FEET

VITALS

BP 140/80MMHG

PR 93 BPM

RR 26CPM

TEMPERATURE 101.4F

SPO2 90%

STSTEMIC EXAMINATION

RS ; BAE PRESENT , NVBS

CVS ;S1 ,S2 HEARED

CNS ; NFND

PA ; SOFT NON TENDER

PROVISIONAL DIAGNOSIS 


IMMEDIATE CAUSE TYPE 1 RESPIRATORY FAILURE

ANTECEDANT CAUSE ALTERED SENSORIUM SECONDARY TO METABOLIC ENCEPHALOPATHY [RECURRENT HYPOGLYCEMIA / HYPOXIA ] IMPENDING DESCENDING TRANSTENTORIAL HERNIATION


Investigation

04/4/24

SEROLOGY HIV NONREACTIVE

HB1AG NON REACTIVE

HCV NOON REACTIVE

DGT O + VE

HEMOGRAM

HB 13.4

TLC 14000

PLT 2.12

MCV 83.9

MCH 28.4

CUE;

ARB ++

SUGAR NIL

PUS CELLS 3.4

EPITHEILIAL CELLS 2-4

RFT

CREATININE 1.2


UREA 33

NA 145

K4

CL 106

URIC ACID 5.4

LFT

TB 0.65

DB 0.19

ALT 13

AST 41

ALP 181

TP 6.8

A/G RATIO 1.33

05/04/24

HEMOGRAM HB 13.5

TLC 16500

PLT 2.12

MCV 84.8

MCH 28.2

RFT

CREATININE 1.2

UREA 53

Na 137

K 4.7

CL 102

URIC ACID 2.9

6/5/24

SEROLOGY

RBS 156

HbA1C 6.6

HEMOGRAM

HB 13.1

TLC 16300

PLT 1.79

MCV 83.8

MCH 27.9

MRI BRAIN PLAIN WAS DONE. SHOWED-T2/FLAIR HYPERINTENSITY WITH RESTRICTION OF DIFFUSION INVOLVING BILATERAL CEREBRAL HEMISPHERES AND BILATERAL BASAL GANGLION.F/S/O SEVERE FORM OF HYPOXIC /HYPOGLYCEMIC BRAIN INJURY.DILATED PERIOPTIC CSF SPACES S/O RAISED ICT.MILD DOWNWARD DESCENT OF BRAIN STEM AND CEREBRAL TONSILS S/O IMPENDING DESCENDING TRANSTENTORIAL HERNIATION.

MDCT SCAN BRAIN PLAIN

;DIFFUSE CEREBRAL EDEMA

Treatment Given(Enter only Generic Name)

RYLES FEEDS 100ML WATER 2ND HOURLY ,200ML MILK 4TH HOURLY

O2 SUPPLEMENTATION +2CO2 TO MAINTAIN SPO2 >96%

INJ MANNITOL 100MG/IV/TID

INJ THIAMINE 100MG /IN 100ML

INJ PAN 40MG IN/OD /7AM

INJ NEOMOL 74ML IU/SOS IF TEMP.101F

INJ MONOCEF 7GM IV/BD

T.DOLO 650MG /RT/SOS IF TEMP >F

DEATH SUMMARY ;

INJ CEVIDIL 1G IV/SOS

INJ DIAZEPAM 2CC+3CC NS [SOS]

INJ LEVIPIL 500MG/IV/BD

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