A 70 year old male came for regular checkup for type 2- diabetes mellitus



 MAY 20th 2024

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here we discuss our individual patient problems through series of inputs from available global online community of experts with an aim to solve this patients clinical problems with collective current best evidence based inputs.



This E-book also reflects my patients centered online learning portfolio and your valuable comments in comment box are most welcome.

    I have Been given this case to solve in an attempt to understand the topic of "patient clinical data analysis"to develop my competency and comprehending clinical data including history,clinical finding investigations and come up with a diagnosis and treatment plan.



   CASE

A 70 year old patient came for regular checkup of type 2 diabetes mellitus 


HISTORY OF PRESENTING ILLNESS

PATIENT WAS APPARENTLY ALRIGHT 8 years BACK THEN HE DEVELOPED DIARRHOEA AND GOT TESTED FOR BLOOD SUGAR LEVEL AND FOUND TO BE DIABETIC. PATIENT STARTED ON MEDICATION SINCE THEN.

NO H/O TINGLING AND NUMBNESS.

NO H/O CHEST PAIN, CHEST TIGHTNESS.

NO SOB, OTHOPNEA, PND.

NO H/O FEVER, COLD, COUGH.

NO H/O BOWEL AND BLADDER ABNORMALITIES.


PAST HISTORY:


K/C/O DM TYPE-2  SINCE 8 years ON METFORMIN-500 MG

N/K/C/O HTN, CVA, CAD,TB, THYROID DISORDERS.


PERSONAL HISTORY:

DIET: MIXED

BOWEL MOVEMENTS: REGULAR

NO KNOWN ALLERGIES

OCCASIONAL DRINKER SINCE 8 YEARS

STOPPED SMOKING 50 YEARS BACK.


FAMILY HISTORY: 

NOT SIGNIFICANT.


GENERAL EXAMINATION:

PATIENT CONSCIOUS/ COHERENT/ COOPERATIVE.

 NO PALLOR, ICTERUS, CYANOSIS, CLUBBING, GENERALISED LYMPHADENOPATHY, EDEMA OF FEET.


TEMP: AFEBRILE.


PULSE RATE: 82 BPM

RR: 20 CPM

BP: 100/70 MMHG

SPO2: 98@ RA

GRBS: 574 MG%









SYSTEMIC EXAMINATION:


CVS: S1 S 2 HEARD. NO MURMURS.


RESPIRATORY SYSTEM:  TRACHE-CENTRAL 

BAE+


P/A: SOFT, NON-TENDER


CNS:  NO FOCAL NEUROLOGICAL DEFECTS




REFLEXES-RT                    LT

BICEPS ++.                           ++

TRICEPS ++                          ++

SUPINATOR +                        +

KNEE ++                               ++

ANKLE +                                +


OPHTHALMOLOGY REFERRAL ON 18/5/24  I/V/O FUNDOSCOPIC EXAMINATION

IMPRESSION- NO EVIDENCE OF DIABETIC RETINOPATHY IN BOTH




COURSE IN THE HOSPITAL-

A 70 YEAR OLD MALE CAME FOR REGULAR CHECK UP FOR TYPE 2 DIABETES MELLITUS.

ALL THE NECESSARY INVESTIGATIONS WHERE SENT.

DIAGNOSED AS UNCONTROLLED SUGARS WITH TYPE 2 DIABETES MELLITUS.

OPHTHALMOLOGY REFERRAL ON 18/5/24  I/V/O FUNDOSCOPIC EXAMINATION

IMPRESSION- NO EVIDENCE OF DIABETIC RETINOPATHY IN BOTH EYES.



INVESTIGATIONS:

On 17/5/24

HEMOGRAM:
Hemoglobin: 12.4 gm/dl
Total Count: 5,500 cells/cumm
Neutrophils: 55%
Lymphocytes: 37%
Eosinophils: 3%
Monocytes: 5%
Basophils: 0%
PCV: 36.6 vol %
MCV: 83.9 fl
MCH: 31 pg
MCHC: 36.9%
RDW-CV: 12.5%
RDW-SD: 38.7 fl
RBC Count: 4.97 millions/cumm
Platelet Count: 2.44 lakhs/cumm

SMEAR:
RBC: Normocytic normochromic
WBC: within normal limits
Platelets: Adequate
Hemoparasites: No hemoparasites seen 
Impression: Normocytic normochromic blood picture.


Total Bilirubin: 1.69 mg/dl
Direct Bilirubin: 0.40 mg/dl


RENAL FUNCTION TESTS:

SERUM ELECTROLYTES:
Sodium: 137 mEq/L
Potassium: 4.0 mEq/L
Chloride: 106 mEq/L

Serum Creatinine: 1.1 mg/dl

 Urea: 24 mg/dl
uric acid: 3.6 mol/l

ESR: 30 MM/1ST HOUR.








ECG:



CHEST X RAY-


 

 





2 D ECHO-






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