HONK

A 70 year old female who is a daily wager by occupation came with Complaints of altered sensorium since afternoon and abnormal posture. 

Patient was apparently asymptomatic till afternoon after which she had her afternoon lunch and took a nap after which her daughter in law observed abnormal behaviour of her not recognising her, murmuring for which she was taken to a near by RMP from there she was referred to our center . 

History of Fever 4 days back which was sudden in onset associated with chills and rigors subsided on taking medication which lasted for one day. 

History of giddiness ( non rotational ) for which she was taken to a near by RMP where she was told she has high blood pressure and was given medication. 

History of neck pain since 3 days for which she went to a near by RMP and took medication. 

Not a known case of hypertension and diabetes. No history of head injury or trauma to head . No complaints of seizures, loss of consciousness, black outs . 

K/c/o alcoholic occasionally. 50 ML over last 45 years 

On examination : tongue : dry 

Dehydration . 

In admission, her GRBS was high @ 8pm 

@9pm @ 9:30pm @10:30pm 

RBS- 9:30pm - 640 mg/dl 

CUE : Sugars ++++

Urine for ketones : negative 

Albumin : Trace 

Na - 131 

K - 4.1 

Cl - 101 

Hb- 12.1 

TLC- 13,800 

N- 65 

L- 25 

E- 05 

B-00 

PLT-1.35

ABG: 

PH - 7.4

PCo2 - 22.4 

PO2 - 84.7 

HCO3 (St) - 16.9 

HCO3 - 14.6 

SO2- 97 %

Diagnosis : ? Metabolic encephalopathy secondary to hyperglycaemic hyperosmolar non-ketotic coma.

Treatment

Insulin infusion @ 40 units HAI IN 39 ML NS @ 6 ML PER HOUR