60 yr/F with sudden loss of consciousness.

 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box.

 25/08/22
60 year old female ,resident of chityala,who is a house wife came with chief complaints of sudden of loss of consciousness On 23/08/22 at 8 pm for 30minutes
HOPI:
patient was apparently asymptomatic 1 day ago ,then  she developed sudden  loss of consciousness for 30 minutes at around 8 pm in the night,(she felt a bit dizzy in the evening and later went to sleep to have some rest while she was asleep around 8 pm she had this episode of loss of consciousness associated with sweating , not associated with chest pain ,fever, palpitations.

She developed the same episode of  loss of consciousness 20 days back for about 30 minutes  early in the  morning 7 am and she was taken to local nalgonda hospital, CT of brain and ecg were done and they  are normal and there she was diagnosed with hypertension.
Past history:
K/c/o type 2 diabetes since 2 years - she is on glibenclamide drug 2mg OD
H/o  hypertension diagnosed 20 days back No h/o thyroid abnormalities, epilepsy,asthma

Family history - no similar complaints

Surgical history -underwent nephrolithotomy for renal stones 20 years ago


Personal history -
Diet- mixed 
Appetite - normal
Sleep -adequate
B&B movements- regular
Addictions-no addictions
No allergies

Treatment history - Glibenclamide 2 mg OD×2 years

General examination -
Patient was conscious coherent coperative well oriented to time,place , person, moderately built and nourished
Vitals-
Temp- afebrile 
BP-160/90
RR-20cpm
PR-60bpm
Systemic examination -
Respiratory system -BAE+
cvs- S1 ,S2 heard
Cns- no focal neurological deficits
Abdomen- soft ,non tender
No pallor ,icterus , cyanosis clubbing lymphadenopathy edema


USG:
2D ECHO

 CHEST X RAY:

Provisional diagnosis:
HYPOGLYCEMIA UNDER EVALUATION

TREATMENT 

1) IV 25D 100 ml stat 

2) NS 75ml / hr 

3) inj octreotide 100mg sc stat 

4) 25 D 50ml / hr

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