59 K. Rithika Vasantha

Greetings!! I'm Rithika, a third semeter medical student. This blog aims at providing a wide array of information of cases evaluated to the best of my understanding. This blog paces up with spectrum of patient centered active learning under the guidance of my experienced seniors. 

A 65 YEAR OLD FEMALE WITH HYPOGLYCEMIA  SECONDARY TO THE PRESENCE OF CANCER

Date of admission: On 5.7.21

Note : The following blog aims at discussing our patient's deidentified health data shared after taking the guardian's signed consent. 

This blog is prepared under the guidance of Dr. Siddharth. 

A 65 year old female came to the casuality in altered state at 3 am. 

CHIEF COMPLAINTS :

• Slurring of speech and profuse sweating since a day before (4. 7.21) , (from evening). 

• And at around 3 am, was brought to casuality in unconscious state, responding to deep stimulation and LOC +

HISTORY OF PRESENT ILLNESS :

• Pt was apparently asymptomatic since yesterday evening 4 pm. 

• Pt had episodes of slurring of speech and profuse sweating ,  1 episode , after food the symptoms were resolved ; and again later she had her dinner and went to sleep. 

• Around 4 am, pt attendees told, that the pt was C/O LOC+ , no involuntary movements, No frothing, no rolling of eyes, responding to deep stimulation, snoring + , And was brought to casuality in unconscious state. 

• At time of presentation, E1 V1 M4, snoring + , sweating + , no involuntary movements and GRBS - 25mg/dl.

• No C/O chest pain, palpitations, syncopal attacks

HISTORY OF PAST ILLNESS :

• In 2014 , pt presented with C/O abdominal pain and abdominal mass ; and on radiological examination, mass was found and later biopsy was planned. 

             And on histopathological examination, GIST was diagnosed and no medication was used. 

• In 2016 , pt was on regular check up, and found out to be  Mets + , referred to MNJ and  surgery was done  for  Mets     , and started on anticancer drugs. { Inabinib 400 mg PO/OD }

• In 2019 , pt was again found it to be having  Mets in large intestine and liver, for which  surgery   was done. 

• In 2020 , PET-CT was done, liver  Mets    size > 16 mm , Sunitinib was started. 

• In 2021 , shifted to Regorafenib 40mg.

• Has h/o diabetes 

No h/o hypertension, CAD, asthma, tuberculosis. 

TREATMENT HISTORY :

• Was on treatment for diabetes - 

    Tab. Gilmi - M1

• Had undergone  blood transfusion - during  surgery for Mets. 

• H/O chemo radiation and surgeries present. 

• No h/o any treatment for hypertension, CAD, asthma, tuberculosis, antibiotics, hormones. 

PERSONAL HISTORY :

• Has normal appetite with a mixed diet. 

• Her bowels were regular and micturition was normal. 

• Has habit of drinking alcohol, occasionally. 

• No h/o smoking, drug use,consumption of betel nut and betel leaf. 

FAMILY HISTORY :

• Has no family history of diabetes, hypertension, heart disease, stroke, cancers, tuberculosis, asthma. 

PHYSICAL EXAMINATION :

• Pallor - present

• Icterus - mild

• Cyanosis - No

• Clubbing of fingers - no

• Lymphadenopathy - no

• Oedema of feet - Yes ( Grade - III) 

VITALS :

• Pulse rate - 92 bpm.

• Respiratory rate - 24/min.

• BP - 130/70 mmHg

• SPO2 at ra - 96%

•  GRBS - 25 mg/dl  -  216 mg/dl

SYSTEMIC EXAMINATION : 

A. CARDIOVASCULAR SYSTEM: 

• No thrills and no cardiac murmurs. 

B. RESPIRATORY SYSTEM : 

• No dyspnoea

•No wheezing sounds present

• Position of trachea - present

• Vesicular breath sounds present

C. EXAMINATION OF ABDOMEN : 

• Distended abdomen

• No tenderness

• Free fluid present

• Liver and spleen not palpable

• Normal bowel sounds present

D. CENTRAL NERVOUS SYSTEM : 

• Pt was conscious

• Speech - normal

• No neck stiffness and no kerning's sign

PROVISIONAL DIAGNOSIS :

    HYPOGLYCEMIA

( ? secondary to OHA's) 

  ?  T GIST   T  Mets  in liver

On chemotherapy, 

      T Vent. Bigeminy

       T First degree heart block

INVESTIGATIONS : 

1. 2D - ECHO :

      Moderate pericardial effusion

      T   dyskinesis of septum

       ? prev.  MI

2 . ECG :

3. Serum Magnesium :

4. LFT :

5. RFT : 

6. Blood Sugar - Fasting : 

7. Hemogram : 

On 5.7.21

On 6.7.21

8.Reticulocyte count : 

9. CRP:

10 . Fever Chart : 

11 . USG : 

TREATMENT : 

 • Inj. HAI  SC / TID

 • GRBS monitoring

 • IVF - 10 NS and 10 DNS } - 50ml/hr

 • Tab. Optineuron

 • Inj. PAN 40mg IV/OD

 • Abdominal girth monitoring

 • Inj. Zoffer 4mg IV /SOS

 • BP / PR / RR monitoring

 • stop OHA's