A 60 year old male with SOB since 6 months

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A 60 year old male,farmer by occupation from Nalgonda came to casualty with complaints of SOB(grade3) on exertion since 6 months 

Indigestion since 4 months

Chest pain since 3 months.

Patient was apparently asymptomatic 6 months back when he developed shortness of breath on exertion(walking for >200mts)

No H/O of orthopnea,PND ,no seasonal and diurnal variations.

Patient complains of chestpain(Right and left sided)

non radiating,burning and spasmodic type of pain.

No H/O excessive sweating,palpitations,pedal edema ,giddiness.No H/O headache,neckpain,vomiting ,loosestools,pain abdomen.

Patient complains of  abdominal distension and bloating sensation after intake of food

PAST HISTORY:

K/C/O Type II DM since 3 years and on unknown medication

Not a k/c/o DM,HTN,CAD,CVA, Epilepsy.

FAMILY HISTORY:

Not significant

PERSONAL HISTORY:

Diet :Mixed

Apetite:Normal

Bowel and bladder Movements:Regular

Sleep:Adequate

Addictions :Tobacco smoker since 35 years stopped 4 years ago

No allergies

Daily routine

(Before diagnosis of  Diabetes MellitusII)

 

3 years back he used to work as a farmer .He wakes up at 5 .Goes for a walk for one hour. He goes to his work at 9 after having bf at 8 am .He comes back at 4 pm ,has his dinner at 8pm and sleeps around 9am. One day all of the sudden he experienced SOB for which he went to a local hospital and was found to have DM type 2 and was given medication.He stopped going to work since then and took rest at his home.

 Due to SOB and fatigue he could not work properly and after he found out to have DM  he decided to stop going to work and take rest at his home and  hence his daily routine is affected after DM

Daily routine(after diagnosis of DM)

Patient wakes up at 5 am in the morning .Goes for walk

for one hour.Takes his breakfast at 8am and

then takes rest.He has lunch at 1 pm and takes afternoon nap.After waking up he sits for sometime later he has his dinner at 8pm and goes to sleep.

GENERAL EXAMINATION:

On examination patient is conscious, coherent, cooperative 

No pallor, icterus, cyanosis, clubbing, lymphadenopathy, edema 

VITALS:

Temp-Afebrile

PR-80bpm 

RR-16Cpm 

BP:100/80mm Hg 

Spo2:96% at room air 

GRBS charting:

12/7/23:

8:30am :273mg/dl

7:00pm:400mg/dl(Glimiperide 1mg BF+ Metformin 500mg)

10:00pm:400mg/dl (8U HAI)

13/7/23:

4:00 am :274mg/dl

8.00am:122mg/dl(6U HAI)

10:00am:271mg/dl(Post breakfast)

1pm-162mg/dl

3pm-250mg/dl

8pm-300mg/dl(Glimi1mg+metformin 500mg)

10pm-186mg/dl

14/7/23

2:00AM-306mg/dl

8.00AM-218mg/dl(Glimi1mg+metformin 500mg)

Systemic examination:

Per abdomen:

Soft,Nontender

Rs:

Bilateral air entry is present.

Normal vesicular breath sounds are heard.

CVS:S1S2 heard.No murmurs

CNS: HMF+,NFND

 Provisional Diagnosis:

Acid peptic disease with uncontrolled sugars(K/C/O 

DM Type2 )

Investigations

Hemogram:

CUE:

LFT:

Serology:Negative

HbA1c:8%

PLBS:450mg/dl

FBS:259mg/dl

Serum creatinine:1mg/dl

Blood urea:23mg/dl

ECG

2D ECHO:

CHEST XRAY:

CLINICAL IMAGES:

Treatment:

1)Injection HAI according to GRBS

2)Tab Pan 40mg PO /OD /7am(BF)

3)GRBS 7 point profile

4) Vitals monitoring 4 th hourly

Advice at discharge:

1)Tab Glimiperide PO/BD(before food)

2)Tab Pan 40mg PO /OD /7am(BF)

3)GRBS 7 point profile

4) Vitals monitoring 4 th hourly

5)Tab Metformin 500mg PO/BD

Followup:

Review after 1 week to OPD