A 45 yrs old male patient presented to the casualty with chief complains of altered sensorium since 7 days 

HISTORY OF PRESENT ILLNESS 

    Patient was apparently asymptomatic 10 yrs back  then he was diagnosed with Diabetes as a part of general check up and he is on medication since then . 6 yrs back he developed ulcerations on left feet little finger which became infectious and gangrenous and finally little finger was amputated .

8 months back he developed similar lesions on his left feet so 4 th toe was amputated .

3 months back following a thorn prick patient developed diabetic foot ulcer following which he had developed plantar abscess , necrotising fascitis and anemia for which he had undergone debriment and split skin graft under regional anaesthesia. Over a month back  he developed  an episode of GTCS with CGS of E3V1M2 and was diagnosed to have hyponatremic seizures with Na+ levels of 117meq/L and he had undergone Na+ correction.

HISTORY OF PAST ILLNESS 

  K/c/o - hypothyroidism 

K/c/o - Diabetes. 

Not k/c/o of Asthma , CAD , tuberculosis , hypertension etc..

Family history : not significant 

Personal history : 

Diet - normal 

Appetite - normal 

Sleep - normal

Bowel and bladder movements - irregular Micturition - abnormal 

GENERAL EXAMINATION 

Pallor - not seen 

Icterus - not seen 

Cyanosis - not seen 

Clubbing - not seen 

Lymphadenopathy - not seen 

VITALS 

Temperature - afebrile 

Pulse - 70/min 

Respiration -18/min 

BP -110/70 mm hg 

SPO2 - 97 % 

GRBS - 55 mg %

SYSTEMIC EXAMINATION 

CVS

S1 and S2 heard 

No thrills and murmurs 

CNS

Level of consciousness - drowsy 

No signs of meningeal irritation

Speech - normal. 

RESPIRATORY SYSTEM EXAMINATION 

Position of trachea - central 

No signs of dysnea and wheezing 

Abdomen examination 

Shape - scaphoid 

No abnormal sounds , tenderness , bruit. 





PROVISIONAL DIAGNOSIS 

K/c/o ? Hypoglycemia and recurrent hyponatremia .

INVESTIGATIONS











TREATMENT 

Inj meropenem 1 gm IU/BD 

Inj metrogyl 100ml /IU 

IV 3% nacl 10ml / HR 

IVF -NS 500 ml /day 

Inj pantop 40mg IU/OD 

Inj Lasix 10mg IU/OD 

Inj piptaz 4.5 gm IU/BD 

Inj optineuron 2ampl in 100ml NS 

Tab thyronorm 25mcg OD.











 







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