A 80 year old male with hypoglycemia

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I have been given this case to solve in an attempt to understand the topic of "Patient clinical data analysis" to develop my competency i reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.  

M.Vineela 

2k18 

Roll no -90

An 80 year old male, a resident of Chityal was brought to the casualty in an unresponsive state at around 6:00am. 

The patient was apparently alright few hours back. The day before he ate at 5 pm and went to sleep.He woke up and then couldn't sleep again at night. He tried sleeping but suddenly got up and then experienced a fall. Went to sleep again without eating anything.

He woke up at around 1:00am to have some food (a glass of milk and rice). He then slept back.

At around 4:00 am he felt uneasy and tried to wake up his wife by tapping her. She didn't respond initially. Later, she saw that he was sweating profusely, had raised body temperature and was unable to see or unable to talk even though there was movement of the neck muscles. 

He was taken to the nearby hospital in Ramanapet where they noticed that his pupils are asymmetric and non- reactive to light.There was increased effort of breathing and fall in BP.

He was treated with IV DNS and O2 supplementation. 

After this he came to our hospital. 

Past history - 

He is not a k/c/o DM, HTN , TB, asthma, epilepsy, CAD,CVA 

Personal history- 

He lives with his wife. He used to work as a shepherd but now stays at home.

His son lives nearby in the same village. 

Diet - mixed

Appetite - decreased 

Bowel & bladder movements - regular

Sleep - adequate 

Addictions -none 

Family history - 

No significant family history 

Vitals - 

Temp - 98.3 F

BP- 160/90 mm Hg 

PR- 88 bpm 

GRBS - 42 mg/dl

spO2- 83% on room air

98% on 8L O2

General physical examination - 

The patient is conscious, coherent and cooperative and well oriented to time, place and person. 

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

Systemic examination - 

CVS - S1, S2 heard 

RESPIRATORY SYS- crepts+, wheeze+ 

CNS- No focal neurological deficits 

GI SYS- non tender , no organomegaly 

Investigations - 

On 14-9-22

Hemogram 

LFT

RFT

ABG 

ECG

Chest x ray

2D echoe 

USG abdomen 

On 15/9/2022 

1st ABG 

2nd ABG

3rd ABG

17/9/2022

18/9/2022

19/9/2022

Provisional diagnosis- 

Recurrent hypoglycemia secondary to insulin secretagogues / sepsis?

Type 2 respiratory failure due to old TB?

Treatment plan - 

1) IVF- NS @ 30 ml/hr

2) INJ. LASIX 20mgIV/BD 

3) TAB.ISONIAZID 75mg

     TAB.RIFAMPICIN 150mg

     TAB. PYRAZINAMIDE 400mg

     TAB. ETHAMBUTOL 275mg

     (3 TAB PO/OD)

4)BP/PR/RR/SPO2/GRBS CHARTING

5) AIR BED.