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Case History and Clinical Findings  C/O ALTERED SENSORIUM SINCE 3 DAYS C/O ULCER OVER LEFT FOOT SINCE 3 MONTHS C/O BURNING MICTURITION SINCE 15 DAYS  HOPI : PATIENT WAS APPARENTLY ASYMPTOMATIC 1 MONTH AGO AND HE HAD ULCER OVER THE LEFT FOOT-3RD TOE NO H/O TRAUMA,INJURY BURNING MICTURITION SINCE 15 DAYS,ALTERED SENSORIUM SINCE 3 DAYS H/O IRRELAVANT TALK,NOT ABLE TO RECOGNISE ATTENDERS9ALTERED SENSORIUM MORE DURING EVENING) N/H/O FEVER,VOMITING,LOOSE STOOLS,PAIN ABDOMEN,GIDDINESS  PAST HISTORY: K/C/O TYPE 2 DMSINCE 25YRS ON INJ HUMAN MIXTARD 10-100 SINCE 20 YRS K/C/O HTN SINCE 20 YRS ON TAB TELMA-H PO/OD PERSONAL HISTORY :  SLEEP-ADEQUATE DIET-MIXED APETITE-NORMAL ADDICTIONS-OCCASIONAL ALCOHOL CONSUMPTION ,H/O SMOKING ,STOPPED 1 YR BACK ALLERGIES-NONE O/E PATIENT IS CONSCIOUS, IRRITABLE, ORIENTED TO TIME, PLKACE, PERSON NO SIGNS OF PALLOR,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY,PEDAL EDEMA  VITALS : TEMP-96.8 F BP-120/70 MMHG PR-78 BPM GRBS-171 MG/DL SPO2-97 ON ...

Case History and Clinical Findings  A 60 YEAR OLD MALE WAS BROUGHT TO CASUALITY IN ALTERED SENSORIUM SINCE YESTERDAY NIGHT PATIENT WAS APPARENTLY ASYMPTOMATIC 10YEARS BACK THEN HE DEVELOPED DM-2 SIMILAR EPISODE THEN HE DIAGNOSED TO HAVE DM-2 AND STARTED ON OHA LATER AFTER FEW YEARS PATIENT WAS SHIFTED TO INSULIN 4YEARS BACK PATIENT DEVELOPED GIDDINESS AND WHILE WORKING PT HAF FALL, FRACTURE RT UL &RT LL, DIAGNOSED WITH HTN ( ON TAB.METOSARTAN CH50, METOPROLOL 50, TELMA 40 ) 2 YEARS BACK PT DEVELOPED SIMILAR COMPLAINTS OF ALTERED SENSORIUM AND WAS HAVING HYPERGLYCEMIA AT PRIVATE HSPTL THEN WAS DIAGNOSED TO HAVE ? DKA ; -GIVEN INSULIN AND TREATEDAFTER THAT;10 DAYS BACK PATIENT DEVELOPED SWELLING OF LOWER LIMBS AND ULCERATION ON RT TOE AND PLANTAR ASPECT OF FOOT FOR WHICH HE WENT TO PUT PRACTITIONER AND DIAGNOSED TO HAVE DIABETIC FOOT AND WAS TREATED WITH REGULAR DRESSINGS AND ANTIBIOTICS LATER 4 DAYS BACK PATIENT DEVELOPED NAUSEA , VOMITING - 2 EPISODES / DAY ASSOCIATED WITH FOOD...

Case History and Clinical Findings  C/O ALTERED SENSORIUM SINCE 3 DAYS C/O ULCER OVER LEFT FOOT SINCE 3 MONTHS C/O BURNING MICTURITION SINCE 15 DAYS  HOPI : PATIENT WAS APPARENTLY ASYMPTOMATIC 1 MONTH AGO AND HE HAD ULCER OVER THE LEFT FOOT-3RD TOE NO H/O TRAUMA,INJURY BURNING MICTURITION SINCE 15 DAYS,ALTERED SENSORIUM SINCE 3 DAYS H/O IRRELAVANT TALK,NOT ABLE TO RECOGNISE ATTENDERS9ALTERED SENSORIUM MORE DURING EVENING) N/H/O FEVER,VOMITING,LOOSE STOOLS,PAIN ABDOMEN,GIDDINESS  PAST HISTORY: K/C/O TYPE 2 DMSINCE 25YRS ON INJ HUMAN MIXTARD 10-100 SINCE 20 YRS K/C/O HTN SINCE 20 YRS ON TAB TELMA-H PO/ODPERSONAL HISTORY : SLEEP-ADEQUATE DIET-MIXED APETITE-NORMAL ADDICTIONS-OCCASIONAL ALCOHOL CONSUMPTION ,H/O SMOKING ,STOPPED 1 YR BACK ALLERGIES-NONE O/E PATIENT IS CONSCIOUS, IRRITABLE, ORIENTED TO TIME, PLKACE, PERSON NO SIGNS OF PALLOR,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY,PEDAL EDEMA  VITALS : TEMP-96.8 F BP-120/70 MMHG PR-78 BPM GRBS-171 MG/DL SPO2-97 ON RA CVS ...

Case History and Clinical Findings  A 60 YEAR OLD MALE WAS BROUGHT TO CASUALITY IN ALTERED SENSORIUM SINCE YESTERDAY NIGHT PATIENT WAS APPARENTLY ASYMPTOMATIC 10YEARS BACK THEN HE DEVELOPED DM-2 SIMILAR EPISODE THEN HE DIAGNOSED TO HAVE DM-2 AND STARTED ON OHA LATER AFTER FEW YEARS PATIENT WAS SHIFTED TO INSULIN 4YEARS BACK PATIENT DEVELOPED GIDDINESS AND WHILE WORKING PT HAF FALL, FRACTURE RT UL &RT LL, DIAGNOSED WITH HTN ( ON TAB.METOSARTAN CH50, METOPROLOL 50, TELMA 40 ) 2 YEARS BACK PT DEVELOPED SIMILAR COMPLAINTS OF ALTERED SENSORIUM AND WAS HAVING HYPERGLYCEMIA AT PRIVATE HSPTL THEN WAS DIAGNOSED TO HAVE ? DKA ; -GIVEN INSULIN AND TREATEDAFTER THAT;10 DAYS BACK PATIENT DEVELOPED SWELLING OF LOWER LIMBS AND ULCERATION ON RT TOE AND PLANTAR ASPECT OF FOOT FOR WHICH HE WENT TO PUT PRACTITIONER AND DIAGNOSED TO HAVE DIABETIC FOOT AND WAS TREATED WITH REGULAR DRESSINGS AND ANTIBIOTICS LATER 4 DAYS BACK PATIENT DEVELOPED NAUSEA , VOMITING - 2 EPISODES / DAY ASSOCIATED WITH FOOD...

Case History and Clinical Findings  PATIENT WAS BROUGHT TO CASUALTY WITH COMPLAINTS OF PAIN ABDOMEN SINCE 4 DAYS AND SWELLING OF LEFT LOWER LIMB SINCE 4 DAYS  HOPI:  PATIENT WAS APPARENTLY ASYMPTOMATIC 4 DAYS AGO THEN SHE DEVELOPED PAIN ABDOMEN WHICH IS INSIDIOUS IN ONSET GRADUALLY PROGRESSIVE. NO AGGRAVATING AND RELEIVING FACTORS. SQUEEZING TYPE OF PAIN PRESENT. H/O FEVER CONTINUOUS TYPE AND RELEIVED ON MEDICATION H/O ANOREXIA,NAUSEA PRESENT NO H/O VOMITINGS H/O ITCHING PRESENT OVER LEFT LEG 5 DAYS AGO K/C/O HTN AND ON REGULAR MEDICATIONN/K/C/O TB,ASTHMA,DM,CVA,CAD,THYROID DISORDERS,EPILEPSY PERSONAL HISTORY:APPETITE IS NORMALDIET IS MIXEDSLEEP ADEQUATEBOWEL AND BLADDER REGULARADDICTIONS- NO FAMILY HISTORY: NO RELAVANT FAMILY HISTORY GENERAL EXAMINATION: PATIENT IS CONSCIOUS, COHERENT,COOPERATIVE.MODERATELY BUILT AND NOURISHEDNO SIGNS OF PALLOR,ICTERUS,CLUBBING,CYANOSIS,LYMPHEDENOPATHY, VITALS:TEMP: 98.6FPR: 78BPMBP: 130/90MMHGRR: 18CPM CVS: S1S2 HEARDRS: BAE+ P/A: SOFT ...

Case History and Clinical Findings  C/O ABDOMINAL DISTENSION SINCE 4 MONTHS ON AND OFF SHORTNESS OF BREATH SINCE 4MONTHS   HISTORY OF PRESENTING ILLNESS PATIENT WAS APPARENTLY ASYMOTOMATIC 4 MONTHS AGO THEN HE STARTED C/O ABDOMINAL DISTENSION WHICH WAS DISTENSION WHICHWAS INSIDIOUS IN ONSET AND GRADUALLY PROGRESSIVE SINCE 1 MONTH ABDOMINAL DISTENSION IS PROGRESSIVE IN NATURE FOR WHICH HE VISITED GANDHI HOSPITAL AND WAS DIAGNOSD AS ALD WITH PORTAL HTN WITH DECOMPENSATED LIVER LIVER DISEASE WITH HEPATIC ENCEPHALOPATHY GRADE 1 WITH RT PLEURAL EFFUSION -MILD.PEDAL EDEMA SINCE 4 MONTHS INSIDIOUS IN ONSET GRADUALIIY PROGRESSIVE ,RELIEVED AT NIGHT ,AGGRAVATED IN THE MORNING [PITTING EDEMA] -SOB DUE TO ABDOMINAL DISTENSON , PRESENT EVEN ON REST ORTHOPNEA AND PND PRESENT NO CHEST PAIN,PALPITATION. C/O DECREASED URINE OUTPUT SINCE 1 MONTH PATIENT IS ON FOLEYS CATHETER SINCE THEN-K/C/O DM 2 SINCE 15 YEARS-OPERATED FOR ILIOPSOAS ABSCESS [10MONTHS AGO]  TREATMENT HISTORY INJ.MIXTARDBD...

Case History and Clinical Findings  54 year male came to casualty on 27-10-22 with complaints of hiccups since 5 days and altered sensorium since morning  HOPI:  Pt was apparently asymptomatic 5 days back then he had continuous hiccups since 5 days Altered sensorium since morning (He had ? up rolling of eyeballs and frothing 1 episode in the morning not associated with any involuntary movements or involuntary micturition or tongue bite) No h/o fever,headache,giddiness,vomiting No other complaints  Past history :  He had similar episode 6 months back2 months back he was admitted in hospital with similar complaints and was found out to have dyselectrolytemia - treated symptomatically K/c/o DM since 7 years ( he had trauma 5 years back to foot which was not healing properly so he went to the hospital and was diagnosed as diabetic) Initially he took medication but his sugars were not under control Then he was switched to insulin under doctor’s advice 20U in the morn...