55yr old male with giddiness secondary to diabetic autonomic neuropathy

DR.CHETANA (INTERN)

DR.NAVYA (INTERN)

DR.ABDUL RAHEEM (INTERN)

DR.ASHFAQ(INTERN)

DR.SRAVYA(INTERN)

DR.GNANADA(INTERN)

DR.CHARAN(PG1)

       

  DR.CHANDANA (PG 1)

DR.SUSMITHA(PG2)

DR.ADITHYA (PG3)

DR.PRANEETH(PG3) 

DR.PRAVEEN NAIK (ASS.PROF)

DR.RAKESH BISWAS(HOD)

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Here is a case I have seen -

Unit 1 admission on 1/3/21-

A 55 yr old male , farmer by occupation came with c/o giddiness since 4 days

C/o generalised weakness since 4 days 
C/o vomitings since 5 days 
HOPI-
Pt was apparently asymptomatic 5 days back later he developed vomitings 
No. Of episodes- 4 to 5 
With food as content , and which was non bilious , non projectile ,and preceded by nausea 
H/o giddiness and fall - 4 days back , no LOC , spontaneous recovery+
H/o fever on and off since 1 week , which was a low grade , intermittent type of fever , associated with chills , relieved on medication 
H/o generalised weakness since 4 days 
H/o polyuria but ( now decreased ), polyphagia ,
Polydypsia ( 3 jugs /days )
H/o burning sensation of feet (now subsided) , tingling sensation of b/l feet -present since 3 years and unable to walk since 1 week 
And is having giddiness after standing 
C/o blurring of vision since 3 years ( cataract -b/l eyes +) , cotton wool sensation on walking is present since 3 years 
No h/o burning micturition
C/o SOB since 4 years 
Which was insidious in onset , gradually progressed from grade 1 to grade 3 .. no c/o orthopnea, and PND 
No h/o chest pain , palpitations , pedal edema , facial puffiness , cough , loose stools 
H/o past illness -
K/c/o diabetes since 8 years 
Not a k/c/o HTN , CAD, EPILEPSY 
H/o 1. diabetic ulcer on right foot - operated on 2013 
2. Diabetic ulcer on left foot - operated on 2017 
Admitted 1 month ago I/v/o deviation of mouth to right , slurring of speech and uncontrolled sugars and was discharged with NPH and ACTRAPID INSUIN ..but Patient himself stopped insulin and used OHA’s since 2 days 
Personal history -
Diet - mixed 
Appetite - Increased 
Bowel and bladder movements- regular 
Consumption of 90ml of alcohol daily since 30years and stopped 1 month ago 
No h/o smoking 
No known allergic history 
General examination-
Pt is conscious, coherent, cooperative , moderately built and nourished 
No signs of pallor, icterus , cyanosis , clubbing, koilonychia, 
Generalised lymphadenopathy, generalised edema 
Vitals -
Bp-120/80 mmhg
PR- 80bpm
RR- 16cpm
Temp-97.8F
GRBS- 216mg/dl
On EXAMINATION-
RESPIRATORY-
Centrally positioned trachea 
Vesicular breath sounds -heard 
No added sounds 
P/A-
Soft ,non tender 
CVS-S1,S2 + , no murmurs 
CNS-

HMF:

Patient is conscious.
Orientation to time, Place & Person +
Speech and language- normal
Memory - intact

CRANIAL NERVES - intact 

MOTOR SYSTEM 
                        Right.                              Left
✓Bulk                 Normal                          Normal

✓Tone                R.                                  L.

Upper limb      Normal                       Normal 

Lower limb     Hypertonia                Hypertonia ( seems to be voluntary )

Power            R.             L. 
UL               4/5.           4/5
                  
LL.               4/5.           4/5
  

All Deep tendon reflexes- absent  

  And abdominal reflex - absent

SENSORY SYSTEM- 

Fine touch - absent in both upper limbs till wrist 

                     Absent in both lower limbs till ankle 

Vibration sense - absent in both upper limbs till elbow

                              Absent in both lower limbs till knee

Cerebellar signs:

No finger nose  in coordination 

No Heel knee in coordination 

No Dysdiadokinesia

Provisional diagnosis -

Giddiness secondary to ? DIABETIC AUTONOMIC NEUROPATHY 

Treatment :-

                          8am     1pm     8pm 

1.INJ. HAI         5U       5U       5U

          NPH         5U       X         5U

2.INJ. PHENARGAN 25mg / IM /TID

3.TAB. PCM 650mg PO SOS