K Vinila Bhavani

 65 yr old female patient , who is a daily wage labourer came to casualty in altered state  with complaints of :

Episodes of slurring of speech since 1 day 

Profuse sweating that resolved on having food. Patient was asymptomatic till yesterday 4 pm . patient was brought to casualty in uncounsious state

 

HISTORY OF PRESENT ILLNESS :

Patient has no involuntary movements .

Patient has history of sweating and snoring .

HISTORY OF PAST ILLNESS :

In 2014 patient was discovered with GIST - gastrointestinal stromal tumour on histopathological examination. 

In 2016 patient was found to be Mets+ve and was treated with anticancer drugs .

In 2019 he was again found to have Mets 16mm in liver .

Eye movements1, verbal1, motor4 

PERSONAL HISTORY :

Diet - mixed 

Apetite - normal

Bowel movements - regular 

Micturition - normal

Patient use to drink alcohol occasionally .

THERE IS NO RELEVANT FAMILY HISTORY .

Patient was having diabetes .


VITALS 

Pallor - yes 

Cyanosis - no 

Icterus - yes ( mild ) 

Lymphadenopathy - no 

Clubbing - no 

Odema of feet - yes 

Pulse rate - 92 bpm

Respiration- 24/Mon

BP - 130/70 mmHg

SPO2 - 96 Percent

SYSTEMIC EXAMINATION :


CVS 

S1 S2 heard with no thrills and no murmurs .


RESPIRATORY :

Normal vesicular sounds, no dyspnea , no wheezing and trachea is central .


ABDOMEN :

Shape - distended

Liver and spleen not palpable .

Bowel - regular .


CNS 

Speech - normal

Level of consciousness - coherent 

No kenings +ve and no neck stiffness .


REFLEXES :

Right 

Biceps 1+, triceps 1+, supinator1+ , knee 1+ and ankle 1+

Left 

Biceps 1+ , triceps 1+ supinator1+ .

PROVISIONAL DIAGNOSIS:

Hypoglycemia secondary to GIST - gastrointestinal stromal tumor and Mets in liver .

On chemotherapy 

T degree heart block 

T vent Bifeminy 

INVESTIGATION :

LFT - liver functioning test .

RFT - renal functioning test .

Random blood sugar 

Haemogram and CRP










TREATMENT :

On treatment for diabetes - tab . Gilmi-M1

Blood transfusion during liver surgery for Mets

Chemo and radiation.

1. Inj HAI SC/tid

2.IVF 10NS 

          10DNS 

3. Optineuron 1 amp 

4.inj Pan 40mg IV/OD

5.inj Zofer 4mg IV /SOS 

6.abd girth monitoring 

7.GRBS monitoring

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