70 yrs old female with slurring of speech and altered sensorium

 70 yrs old female bought to the casuality in unresponsive sate with cheif complaints of 

Slurring of since 1 day ( 07-07-2022 ) 

Altered sensorium since 1 day (07-07-2022)


HOPI : 

Patient was apparently asymptomatic 1 day back and on thursday morning she developed slurring of speech and giddiness then they went to a hospital in miryalguda , they found increased levels of sugars ( >500 mg/dl ) and thought giddiness was due to increased sugar levels and given treatment to reduce sugars, despite of which symptoms doesn’t relieved , on thursday night patient was bought to our hospital in unresponsive state. 

Blood in the stools 2 days back 

HCV +ve


Daily routine: 

Wake up - 8:00 am 

Completes her daily household activities 

Tiffin - 9:00am 

Lunch - 12:30 pm

Dinner-8:30 pm

Sleep - 9:30 pm


Past history : 

K/C/O - hypertension since 10 yrs ( on medication TELMA 20 mg ) 

K/C/O- Asthma 

Diabetes- diagnosed 1 day back ( 07-07-22) 

No history of epilepsy, thyroid,Tb . 


Personal history : 

Diet - mixed 

Appetite- normal 

Sleep - disturbed 

Bowel and bladder - regular  

Addictions - 

Toddy drinker 

Smokes bd 


Treatment history 

For hypertension- TELMA 20 mg 


GENERAL PHYSICAL EXAMINATION

Patient is unconscious 

Pallor :- 
Clubbing: 
Icterus :- 
Cyanosis :- 
Lymphadenopathy :-
Pedal Edema :-

Vitals 

BP -120/80 mmhg 

PR - 82BPM 


Systemic examination 

CVS - S1S2 + ve 

RS - BAE + 

P/A - soft 

CNS 


Tone     Rt                                                Lt 

           UL and LL hypertonic            UL and LL hypertonia 



Investigations 



Provisional diagnosis 

Altered sensorium under evaluation 

Secondary to Acute CVA ? 


Treatment 

 

Iv fluids - NS /RL/ DNS - @70 ml/hr

Inj pan 40 mg -  IV/OD

Inj optineiron - amp in 100 ml NS/IV/OD 

Inj THIAMINE  1 gm /IV/stat

BP/PR/SP O2 monitoring - 4 th hourly 

GRBS MONITORING - 

Tab TELMA 20 mg PO/OD 

Inj HAI S/C TID ACC to GRBS 








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