A 70 years old female with history of fall
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A 70 year old female home maker since 10-15years ( farmer by occupation before) ,resident of narammagudem, came to casuality in drowsy state .
HISTORY OF PRESENTING ILLNESS:
patient was apparently asymptomatic 11 years back, then the patient had a history of fall , she went to local hospital and got diagnosed with diabetes millitus and since then she is on OHA medication ( glimiperide M2) .
4 years back she had another history of fall , she went to local hospital and got diagnosed with hypertension, and she developed edema , and also undergone dialysis , she is not on medication for hypertension.
1month back she developed hypoglycaemia secondary to OHA's then resolved later .
8 days back she had another history of fall which lead to fracture of rt femur , and was operated ( open reduction and internal fixation).
after 3 days she developed edema , became drowsy, was not able to open eyes fully and responded to deep pain, was not able to recognise the attenders .
she is having abdominal distension and vomiting since 1 day , 3 episodes of vomiting ,billious, non projectile.
PAST HISTOR:
known case of diabetes since 11yrs and on medication
known case of hypertension since 4yrs
FAMILY HISTORY:
no significant family history
SOCIAL HISTORY :
she is the only person in the house who cooks on her self and does her regular activities .
GENERAL EXAMINATION:
patient is drowsy , moderately built and moderately nourished
Pallor: present
Icterus: absent
Cyanosis: absent
Clubbing : absent
Odema of feet: pitting type of edema seen
Lymphadenopathy: absent
Vitals on admission :
BP: 170/90 mmHg
PR: 98 bpm
RR: 25cpm
Spo2: 95
Grbs:146
SYSTEMIC EXAMINATION:
CVS: S1 and S2 heard
Respiratory system: bilateral air entery present
Per abdomen :
Inspection: rounded, no scars
palpation: slightly warm, non tender, no organomegaly
percussion: resonant sound heard on percussion
auscultation: bowel sounds heard
CNS: patient is drowsy
tone is normal
INVESTIGATIONS:
ON 12/2/2022:
Hb: 5.8
TLC: 11,000
smear: microcytic hypochromic anemia
RBS: 220
ESR: 140
Blood urea: 143
ON 13/2/2022:
Hb: 6.1
TLC: 11,500
she had a blood transfusion
ON 15/2/2022:
Bp: 170/90mmHg
Pr: 98bpm
Rr: 22cpm
Grbs:146mg/dl
INVESTIGATIONS:
ULTRA SOUND ON ADMISSION:
RT LOWER LIMB VENOUS DOPPLER:
CT BRAIN:
USG ABDOMEN:
CT ABDOMEN:
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