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
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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