50 year old male with loss of consciousness
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This is a case of 50 year old male who is farmer resident of azarguda came on 27 december 2022 with chief complaints of
CHIEF COMPLAINTS
Sudden fall and Loss of consciousness at farm at 11AM on 27 december 2022
HISTORY OF PRESENTING ILLNESS
patient was apparently asympotomatic 7 days back. He was fine till 10 Am on 27 december 2022 he went to field without taking his regular insulin dosage before eating food
He suddenly fell down and had loss of consciousness while working in fields which was not associated with any aura or involuntary movements of the limbs
There were no uprolling of eyelids ,frothing from the mouth
History of blurring of vision since 4 months
History of nocturia,polyuria and dysuria since 2 months
History of tingling sensation in the legs occasionally
History of dry cough intermittently since 10 days
No history of burning micturition, no history of palpitations,no history of shortness of breath,no history of fever ,no history of nausea and vomiting
SEQUENCE OF EVENTS
10 years back he had polyuria and giddiness and went to hospital where He was diagnosed with diabetes mellitus and was on oral hypoglycemic agents(tab glimepiride 1 mg + tabmetformin 1000 mg BD)used to take medications daily,but did not have any dietary modifications and life style changes due to lack of awareness
6 months back He was diagnosed with hypertension and was given tab cinidipine 10 mg OD but he took medication only for 15 days and then stopped using them
1 month back He was having backache and came to our hospital were he was diagnosed with CKD and renal stone for which medications were given and he was not compliant to the medication
Since 1 month he was shifted to insulin from oral hypoglycemic agents
7 days back He didnot take insulin and went to field to work were he suddenly had loss of consciousness and was brought to river nims hospital at nalgonda and LAMA and was brought to our hospital on 27 Dec 2022 evening
DAILY ROUTINE
He wakes up at 6 AM performs his daily routine eats breakfast by 9 AM usually rice he mostly skips breakfast and goes to fields take lunch along with him and eats lunch by 1-2pm and come back home at 5-6pm and drinks tea and sits with friends for some time and watches television eats dinner by 9 PM and sleeps which is usually rice currently he smokes 2 beedis per day
PAST HISTORY
No similar complaints in the past
no history asthma,epilepsy,thyroid disorders,TB
No history of previous surgeries
No history of blood transfusions
PERSONAL HISTORY
DIET : mixed
APPETITE: normal
BOWEL AND BLADDER : bowel movements normal
Bladder movements:polyuria ,nocturia ,dysuria
SLEEP : adequate
ADDICTIONS : smoker(beedi) since 35 years used to smoke 2 packets daily but reduced to 2 beedis per day since 1 month
occasional intake of alcohol
FAMILY HISTORY
History of diabetes mellitus in mother and she died because of hyperglycemia
TREATMENT HISTORY
no significant Treatment history
GENERAL EXAMINATION
patient was conscious, coherent, cooperative
Well oriented to time,place,person
Moderately build and moderately nourished
No pallor, icterus,cyanosis,clubbing,lymphadenopathy and edema
VITALS
Pulse rate:70bpm
BP: 170 /90mmhg in supine position
RR:16 cpm
Temperature :afebrile
GRBS:240 mg/dl
SYSTEMIC EXAMINATION
RESPIRATORY SYSTEM:
Investigations on 1 Jan 2023
Nephro referral on 29 december 2022
Bacterial culture and sensitivity
Altered sensorium secondary to hyperosmolar non ketotic coma
Hypertensive urgency with severe Uncontrolled hypertension with AKI on CKD
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