60/f with altered sensorium 2° hyponatremia

C/o generalised weakness since 2 months
Body pain (+)
C/o pain abdomen since 8 days


Patient is a diabetic since 20 years initially on OHA later shifted to insulin Mixtard (30/70) since 1 week because of high sugars .

She was apparently assymoptomatic 2 months back ,then she used to complaint of generalised body pains and weakness .
No fever ,no vomitings ,no loose stools.
Since 8 days patient is complaining of pain abdomen - diffuse , intermittently 
No vomitings ,no loose stools .
For the above complaints she was taken to RMP and got symptomatic treatment ,but found to have high sugars ,so they visited local doctor in nalgonda ,where her previous OHA was changed to Insulin.

Now she presented to us with complaints of 
Decreased urine output
Pedal edema , abdominal distension since 3 days .
With decreased food intake ,droswiness
Constipation since 2 days
H/o usage of T. aceclofenac 100mg po od since 3 days


Pt is a k/c/o DM-TYPE2 since 20 years, initially on OHA, since 20 days is on Human Mixtard Insulin (30/70) (30u--x--30u)
N/k/c/o htn, TB, BA, CAD, CVA,thyroid disorders

O/e 
BP- 120/70mmhg
Pr- 81 BPM
RR- 16cpm
TEMP- afebrile
GRBS-319mg/dl

No pallor, icterus, cyanosis clubbing lymphedema. Edema of feet present (grade 2)

CVS- S1 S2 heard
Rs- BAE (+) crepts in left IAA, IMA heard
P/A- soft, distended, umbilicus transversly split, diffuse tenderness
CNS- altered, not oriented to t/p/p



Provisional diagnosis- anasarca
Uncontrolled blood sugars
AKI


Diagnosis-
Altered sensorium 2° to hyponatremia with AKI with ? hepatitis with right renal calculi
With DM-type 2 with uncontrolled sugars

Rx-
IVF- ns, RL up+ 50ml/hr
Inj. Lasix 40mg iv bd
Inj. 3% NaCl @20ml/hr
Inj. Pan 40mg iv od
Inj. ZOFER 4mg iv SOS
Inj. Tramadol 1amp in 100ml NS IV/tid
Inj. Neomol 1gm iv SOS
T. PCM 500mg po/sos
I/o charting
Vitals monitoring
GRBS- 7 Point profile

                  Soap notes (1/1/22)
S- 
O-  BP- 110/70mmhg
Pr- 78 BPM
RR- 16cpm
TEMP- afebrile

No pallor, icterus, cyanosis clubbing lymphedema. Edema of feet present (grade 2)

CVS- S1 S2 heard
Rs- BAE (+) crepts in left IAA, IMA heard
P/A- soft, distended, umbilicus transversly split, diffuse tenderness
CNS- altered, not oriented to t/p/p

A- Altered sensorium 2° to hyponatremia with AKI with ? hepatitis with right renal calculi
With DM-type 2 with uncontrolled sugars
P- IVF- ns, RL up+ 50ml/hr
Inj. Lasix 40mg iv bd
Inj. 3% NaCl @20ml/hr
Inj. Pan 40mg iv od
Inj. ZOFER 4mg iv SOS
Inj. Tramadol 1amp in 100ml NS IV/tid
Inj. Neomol 1gm iv SOS
T. PCM 500mg po/sos
I/o charting
Vitals monitoring
GRBS- 7 Point profile

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