HHS with Diabetic chorea.

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 is welcome.

Team:

Interns-

M Supriya

Mohitha

K Sowmya

Sanjay

Amrutha


Dr.Druga Krishna PGY1

Dr.Ajith Kumar PGY2

Dr.Laxma Reddy PGY3

Dr.Manasa PGY3

Dr.Vijaya Lakshmi (Ast.Prof.)


70yr old male agricultural labourer from Akkinepalli presented with 

C/o weakness of right upper limb and right lower limb and difficulty in walking from 3 days with involuntary movements of right upper limb.

C/o slurring of speech from 3days .

C/o increased frequency of micturition from 3 days.

The patient was apparently alright 3 days back later he developed slurring of speech which was sudden in onset and gradually progressive. He had difficulty in walking and lifting his right upper limb from 3 days. Initially it started as tingling and numbness which progressed to weakness in the right upper and lower limbs. He has involuntary movements of his right upper limb from 3 days.

K/c/o CKD from 5 months(no records found).

H/o left hip surgery 5 months back due to fall. During this time he was diagnosed with Type 2 Diabetes Mellitus. He used medication for 4 days only for the Diabetes.

Not a k/c/o Hypertension, epilepsy, TB, bronchial asthma, CVD, thyroid disorders.

He has been drinking regularly from 20 yrs. He drinks whiskey 180ml/day.

Sleep adequate. 

He has a good appetite and a mixed diet.

Bowel movements-regular.

Increased frequency of micturition from 3 days.

No known allergies.

O/E : 

Patient is conscious, coherent, cooperative.

Afebrile.

Bp-140/80mmHg right arm, supine position.

PR- 90/min,regular, normal volume.

RR- 16cycles/min

Spo2-98% @room air

Involuntary movement in right upper limb.


CNS Examination:

Pupils -NSRL

Power 4-/5 in both upperlimbs

4+/5 in both lowerlimbs

Tone -hypertonia+ in all 4limbs

Reflexes -brisk in all four limbs 

Plantars- mute

CVS-S1S2+ no murmers

Resp-NVBS+

P/A -soft , non tender.


INVESTIGATIONS: 

RBS- 875mg/dl

HbA1c- 8.1%

Serum Osmolality-318


RFT- 

Urea-90

Creatinine-2.7

Potassium-2.7

Chloride-94

Sodium-125


LFT- 

TB-1.81

DB-0.45

SGOT-25

ALT-11

ALP-475

Total Protein-6.7

Albumin-4.03

   

ABG-

pH-7.34

pCo2- 35.3

pO2-105

HCO3-18.9


Urine Sodium-137 mmol/L

Spot Urine Potassium- 11.5

Urinary Chloride- 187mmol/L

Serology-Negative.

ECG:

 


Chest Xray:


USG Abdomen:


PROVISIONAL DIAGNOSIS: Hyperosmolar hyperglycemic state  with DIABETIC CHOREA with hypertonic hyponatremia secondary to hyperglycaemia.

TREATMENT-

1.Inj.HAI 6U/IV

2.Inj.KCl 2amp in 1 unit NS @50ml/hr

3.IV fluids- 1 unit NS, 1 unit RL

4.Condom catheterisation .


Daily charting:

GRBS charting:


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