72Y/F / DIABETIC CHOREA unit 3

Treating doctors

Dr.Aravind

Dr. Rashmitha

Dr.Pradeep

Dr. Shailesh

This patient was admitted on 18/November 2020 and went lama next day. And blog is being made later by another doctor (me) for academic purposes.

 

A 72 year old female was brought to the casualty with

C/o Involuntary movements of Rt UL 1day ago at 2pm for 2 hrs

C/o vomitings 1day ago

C/o altered sensorium since today 

Pt was apparently alright 2days ago , then she developed sudden onset of involuntary movements of Rt UL which lasted for 2hrs which stopped after taking levipil 500mg

C/o vomitings at 1am 2 episodes , non bilious and 3 episodes at 9am foul smelling non projectile , non bilious , food as contents.

C/o Altered sensorium from today morning , not recognising anyone 

No h/o fever , headache , blurring of vision , involuntary passage of stools or urine

She is a k/c/o DM 2 since 15yrs and she is on Glimepiride 1mg + Metformin 500mg 

K/c/o HTN since 10years

Post CABG in aug 2014 (no records available)

PTCA + Stent to LCX 

On examination :

Pt is C ,C 

No Pallor , Icterus , Clubbing , Cyanosis , Lymphadenopathy,pedal edema

Vitals :

Afebrile

Pulse : 96bpm

Resp rate : 23/min

Bp : 150/90 mm hg

Grbs : 528 mg %

CVS : S1,S2 heard, no murmurs

Resp rate : NVBS present , BLAE present

CNS : No focal neurological deficits

Diagnosis : 

Altered sensorium under evaluation(? HHS)

Treatment given:

1) Inj Insulin 50units in 50ml NS @5ml/hr

2) IVF NS @150ml/hr 

3) Inj Ceftriaxone 1gm IV BD 

4)Inj PAN 40mg IV OD

5)Inj Zofer 4mg IV TID