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PERIPHERAL NEUROPATHY (SENSORY &MOTOR) DIABETES MELLITUS SINCE 30 YEARS HYPERTENSION SINCE 30 YEARS CHRONIC KIDNEY DISEASE SINCE 13 YEARS BENIGN PROSTATIC HYPERPLASIA

 Case History and Clinical Findings C/O GIDDINESS SINCE 15 DAYS HOPI- PATIENT WS APPARENTLY ASYMPTOMATIC 15DAYS AGO THEN DEVELOPED EPISODES OF GIDDINESS A/W BLURRING OF VISION A/W SWEATING RELIEVED AFTER TAKING FOOD DAILY ONE EPISODE H/O CHEST PAIN SINCE 4DAYS PRICKING TYPE ON AND OFF ,NO PRECIPITATING FACTORS H/O TINGLING AND NUMBNESS OF LOWER LIMBS SINCE 10 YEARS EXTENDING FROM TIP OF TOES TO SHIN OF TIBIA H/O BURNING SENSATION OF FEET SINCE 5 YEARS H/O LOOSE STOOLS FOR 1 DAY WHICH WAS ONE WEEK AGO AND SUBSIDED ON MEDICATION FOLLOWED BY PAIN ABDOMEN IN UMBLICAL REGION SINCE THEN NO H/O LOSS OF APPETITE SINCE 1 WEEK NO H/O POLYURIA,POLYDIPSIA NO H/O PALPITATIONS ,SOB NO H/O HYPOGLYCEMIC EVENT AT NIGHT NO H/O DECREASED URINE OUTPUT ,BURNING MICTURITION NO H/O FEVER, PEDAL EDEMA ,FACIAL PUFFINESS PAST H/O- K/C/O HTN SINCE 30YRS AND ON T.TELMA AM 40/5 K/C/O DM SINCE 30 YRS ON INJ MIXTARD 20U(BBF)-X-15U(BBF) K/C/O CKD SINCE 13 YEARS ON EXAMINATION PT IS CONSCIOUS, COHERENT,COOPERATIVE TEM
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ACUTE GASTRITIS K/C/O DIABETES MILLETUS SINCE 30 YEARS K/C/O HYPERTENSION SINCE 10 YEARS CHRONIC KIDNEY DISEASE STAGE 4

 Case History and Clinical Findings CHIEF COMPLAINTS : DIFICULTY IN BREATHING SINCE 2 MONTHS, HARD STOOLS SINCE 1MONTH , BLOATING OF ABDOMEN SINCE 1MONTH , GIDDINESS SINCE 1 WEEK HOPI: PATIENT WAS APPARENTLY ASYMPTOMATIC 2 MONTHS BACK THEN HE DEVELOPED DIFFICULTY IN BREATHING WHICH IS OF GRADE 2 WITH NO AGGREVATING AND RELEIVING FACTORS COMPLAINTS OF HARD PELLET STOOLS WITHOUT ANY BLOOD TINGE SINCE 1 MONTH C/O BLOATING OF ABDOMEN SINCE 1 MONTH N/H/O CHEST TIGHTNESS N/H/O ORTHOPNEA PND N/H/O BLEEDING MANIFESTATIONS PAST HISTORY : K/C/O HYPERTENSIOPN ON TAB.CINOD 10 MG BD SINCE 10 YEARS K/C/O DM SINCE 30 YEARS ON INJ.HAI 8-10-8 K/C/O CKD SINCE 13 YEARS ON NODOSIS 500 MG PERSONAL HISTORY: DIET: MIXED APPETITE: NORMAL BOWEL AND BLADDER MOVEMENTS: REGULAR. NO KNOWN ALLERGIES AND ADDICTIONS. FAMILY HISTORY: NOT SIGNIFICANT. GENEREAL EXAMINATION: PATIENT IS C/C/C TEMP: AFEBRILE PR: 80 BPM RR: 20 CPM BP: 110/70 MMHG SPO2: 98 @ RA. SYSTEMIC EXAMINATION: CVS: S1 S2 HEARD. NO MURMURS RESPIRATORY
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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 FEE
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DIABETIC KETOACIDOSIS [RESOLVED] WITH DENOVO DIABETES MELLITUS SECONDARY TO ACUTE ON CHRONIC PANCREATITIS

 Case History and Clinical Findings C/O PAIN ABDOMEN SINCE 3 DAYS. PATIENT WAS APPARENTLY ASYMPTOMATIC 3 DAYS AGO THEN HE DEVELOPED PAIN ABDOMEN SINCE 3 DAYS INSIDIOUS IN ONSET, LEFT LUMBAR REGION, SPASTIC TYPE OF PAIN,NON RADIATING. A/W VOMITING 3 EPISODES PER DAY A/W LOSS OF APPETITE SINCE 3 DAYS H/O CONSTIPATION SINCE 3 DAYS,STEATORRHOEA H/O BLOATING NO H/O FEVER ,LOOSE STOOLS NO H/O BURNING MICTURITION NO H/O DECREASED URINE OUTPUT PAST HISTORY: H/O SIMILAR COMPLAINTS IN THE PAST N/K/C/O HTN,DM,CVA,CAD,EPILEPSY,ASTHMA NO PALLOR ,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY,PEDAL EDEMA. VITALS: BP:130/80 TEMP:97 RR:31 COURSE IN HOSPITAL: THIS IS A CASE OF 36 YR OLD MALE CAME WITH C/O PAIN ABDOMEN SINCE 3 DAYS A/W VOMITINGS 3-4 EPISODES PER DAY.PATIENT WAS EVALUATED AND DIAGNIOSED WITH DIABETIC KETOACIDOSIS,ACUTE O CHRONIC PANCREATITIS PATIENT WAS ADVISED FOR CECT ABDOMEN I/V/O PANCREATITIS BUT PATIENT AND ATTENDR DENIED FOR IT. ANTIBIOTICS ADEQATE,REHYDRATION WITH FLUIDS,SUGAR CONTROL
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SEPTIC SHOCK WITH MULTIPLE ORGAN DYSFUNCTION (RESOLVED) SECONDARY TO LEFT DIABETIC FOOT S/P: DISARTICULATION OF LEFT GREAT TOE(13/04/2024) K/C/O TYPE 2 DIABETES MELLITUS SINCE 6 YEARS 1 PRBC TRANSFUSION DONE

 Case History and Clinical Findings CHIEF COMPLAINTS: WOUND OVER THE LEFT FOOT SINCE 4 MONTHS HISTORY OF PRESENT ILLNESS: PATIENT WAS APPARENTLY ASYMPTOMATIC 4 MONTHS BACK, AFTER WHICH SHE DEVELOPED BLACKISH DISCOLORATION OF LEFT GREAT TOE WHICH WAS INSIDIOUS IN ONSET ,GRADUALLY PROGRESSIVE , ASSOCIATED WITH SWELLING OF THE INVOLVED LIMB TILL MID FOOT FOR WHICH SHE WENT TO A LOCAL RMP AND WAS TREATED WITH DRESSING .THERE WAS NO IMPROVEMENT, WITH PROGRESSION OF WOUND , ASSOCIATED WITH FOUL SMELLING DISCHARGE FOR WHICH SHE WAS TAKEN TO AN OUTSIDE HOSPITAL WHERE DISARTICULATON OF LEFT GREAT TOE WAS DONE UNDER REGIONAL ANESTHESIA ON 13/04/24. CAME ON LAMA TO OUR HOSPITAL FOR FURTHER MANAGEMENT NO H/O FEVER,COUGH,COLD. NO H/O CHEST PAIN,PALPITATIONS,BREATHLESSNESS,ORTHOPNEA,PND. NO H/O ABDOMINAL PAIN,BURNING MICTURITION,NAUSEA,VOMITING. HISTORY OF PAST ILLNESS: K/C/O TYPE 2 DIABETES MELLITUS SINCE 6 YEARS (ON TAB GLIMI M1/OD) NO H/O HYPERTENSION,ASTHMA,TB,EPILEPSY,CVA,CAD,CKD,CLD. TREATMENT
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ENTERIC FEVER DIABETES MELLITUS SINCE 9 YEARS HYPERTENSION SINCE 1 WEEK WITH ANEMIA-MCHC SECONDARY TO NUTRITIONAL CAUSE

 Case History and Clinical Findings C/O FEVER SINCE 2WEEKS HISTORY OF PRESENT ILLNESS : PATIENT WAS APPARENTLY ASYMPTOMATIC 2 WEEKS BACK AND THEN SHE DEVELOPED FEVER 2 WEEKS A/W CHILLS AND RIGORS ANS RELIEVED IN BETWEEN BUT SINCE TODAY MORNING THE FEVER IS PRESENT ,HIGH GRADE ,CONTINOUS TYPE A/W CHILLS AND RIGORS ,HEADACHE +,NO AGGRAVATING AND RELIEVING FACTORS NO H/O BURNING MICTURATION NO H/O PAIN ABDOMEN , VOMMITINGS NO H/O CHEST PAIN , PALPITATIONS NO H/O COLD , COUGH NO H/O PEDAL EDEMA,DRUG NON COMPLIANCE HISTORY OF PAST ILLNESS : K/C/O DM SINCE 9 YEARS AND ON INJ HAI/SC/TID 16U-16U-16U INJ NPH SC /BD 14U-X-14U K/C/O HTN SINCE 6 DAYS AND ON TAB TELMA 20MG PO/OD N/K/C/O THYROID DISORDERS , ASTHMA , TB , EPILEPSY , CAD , CVA MENSTRUAL HISTORY : HYSTERECTOMY DONE 9 YEARS AGO ON EXAMINATION PT IS CONSCIOUS, COHERENT,COOPERATIVE TEMP-101 F PULSE RATE 92 BPM BP 140/90 MMHG GRBS -256MG/DL CVS-S1 S2 HEARD NO MURMURS RS- BAE PRESENT NVB P/A-SOFT,NON TENDER PROVISIONAL DIAGNOSIS ENTERIC FEV
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CARDIOGENIC PULMONARY EDEMA SECONDARY TO CAD HEART FAILURE WITH MIDRANGE EJECTION FRACTION (EF 40%) K/C/O CKD SINCE 1 YR K/C/O DM 2 SINCE 10 YEARS

 C/O SHORTNESS OF BREATH SINCE YESTERDAY 10PM HOPI PATIENT WAS APPARENTLY ASYMPTOMATIC BEFORE 10PM YESTERDAY SUDDENLY SHE HAD SHORTNESS OF BREATH WHICH IS SUDDEN IN ONSET GRADUALLY PROGRESIVE (GRADE 2 NYHA ) NO H/O FEVER, COUGH, COLD, VOMITINGS, DIARRHOEA, BURNING MICTURITION, DECREASE IN URINE OUTPUT SHE HAD SIMILAR COMPLAINTS ON 1/3/24 AND ADMITTED IN GOVERNAMENT HOSPITAL AND TREATED THERE DISCHARGED ON 3/3/24 AND THEN SHE RECOVERED K/C/O CKD WITH DIABETIC NEPHROPATHY AND ADMITTED IN OUR HOSPITAL WITH COMPLAINTS OF VOMITINGS AND EPIGASTRIC PAIN ON 16/9/23 AND DISCHARGED ON 19/9/24 PAST HISTORY K/C/O DM SINCE 10YRS ON TAB GLIMI M1 PO/OD NOT USING ANY MEDICATION SINCE NOV 2023 NO H/O DM, TB, ASTHMA. HTN, EPILEPSY GENERAL EXAMINATION PT IS C/C/C TEMP - 98.6F PR - 130BPM RR - 30CPM BP - 130/80MMHG SPO2 - 86% @ RA GRBS - 464MG % SYSTEMIC EXAMINATION CVS - S1, S2 +, NO MURMURS CNS - NFND RS - B/L DIFFUSE FINE CREPTS PRESENT P/A - SOFT NONTENDER PULMO REFERAL WAS DONE I/V/O ? PULMONARY TB A
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