Short case


HONC leading to altered sensorium

This is an online e-log book to discuss our patient's de-identified health data shared after taking his/her/guardian's informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.

Date of admission :  04 February 2022

A  50 year old male who works in a hotel came to the OPD with the chief complaint of loss of consciousness 


History of present illness : 

The patient was apparently asymptomatic one day before.

He had a night meal with 90 ml of whisky which was his daily routine.

He later experienced discomfort, started behaving abnormally as in talking irrelevant things and lost consciousness.


History of past illness :

Patient is diabetic since 15 years (experienced giddiness and got checked)

The patient was injured by a motor vehicle silencer  4 months back and the injury later progressed to form an ulcer leading to amputation of three toes of right leg.

The patient is not a known case of epilepsy, tuberculosis, asthma, hypertension



Personal history : 

- The patient has no loss of appetite

- He takes mixed diet

- No sleep disturbances

- He stopped smoking 15 years back but consumes alcohol occasionally 


Family history :

- There are no similar complaints in the family members


Treatment history :

- The patient is on oral hypoglycemic agents (glimepiride) but has a habit of skipping the medications.

- She is not a known case of drug allergy.


General examination :

- Patient is not conscious, coherent, cooperative at the time of joining

- Pallor present

- No icterus

- No cyanosis

- No clubbing of fingers and toes

- No lymphadenopathy

- Bilateral pedal edema is absent

Vitals : temperature - 91°F

             Pulse rate - 91 bpm

             Respiratory rate - 24 cycles per minute

             BP - 220/100 mm Hg

             GRBS : 524 mg 








Systemic examination : 


CVS

Inspection - chest wall is bilaterally symmetrical

- No precordial bulge 

- No visible pulsations, engorged veins, scars, sinuses

Palpation - JVP is normal

Auscultation - S1 and S2 heard


RESPIRATORY SYSTEM

- Position of trachea is central 

- Bilateral air entry is normal

- Normal vesicular breath sounds heard

- No added sounds


PER ABDOMEN 

- abdomen is tender

- bowel and bladder sounds heard

- no free fluid or mass present 


CNS

- Patient is not conscious

- Speech couldn't be assessed

- Reflexes are normal


Investigations : 



Diagnosis : Altered mental status secondary to Hyper osmolar non ketotic coma.

Treatment : 

IVF NS @100 ml/hr

Inj. Thiamine 11 amp in 100 ml/NS/IV/OD

Inj. Zofer Umg/IU/SOS

Inj. Morocef 1 gm/IU/BD

T. Quitiapine 25 mg

Inj. Lorazepam 1/2 amp IV/SOS

Inj. HAI s/c acc to GRBS

GRBS monitoring









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