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PRESENTATION - KASTHURI1.pptx

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DISCUSSION • NAME : KASTHURI • AGE : 67 • SEX : FEMALE • THIN BUILT • KNOWN CASE OF T2DM / SHT / POLYARTHRITIS / FUNCTIONAL PSYCHOSIS • ON REGULAR TREATMENT FOR DM FOR THE PAST 15 YEARS • VEGETARIAN , NOT A SMOKER, ALCOHOLIC, TOBACCO CHEWER
COMPLAINTS • DECREASED INTAKE OF FOOD • VOMITING ON AND OFF FOR ONE • GENERALISED WEAKNESS MONTH • IRRELEVENT TALKS ON AND OFF • H/O WITHDRAWAL OF ALL DRUGS FOR MORE THAN ONE MONTH
HISTORY • SHE DIAGNOSED AS T2DM IN 1997 WHILE SHE WENT FOR AN EYE CHECK UP. • HER PARENTS DETAILS ABOUT DM IS NA • HER HUSBAND IS DIABETIC • HAVING TWO SONS AND THREE DAUGHTERS. IN THAT, EXCEPT ONE LAST SON, ALL ARE DIABETIC • SHE UNDERWENT CATERACT SURGERY BEFORE 4 YRS FOR ONE EYE AND 1YR FOR ANOTHER EYE. • VERY REGULAR Pt.
OLD RECORDS DATE FBS PPBS 15.11.08 140 221 0912.08 110 242 09.01.09 144 176 19.01.09 284 378 19.02.09 186 320 20.03.09 134 169 21.04.09 112 221 21.05.09 134 241 20.06.09 132 160 22.10.09 142 248 08.06.10` 212 282 09.12.10 164 217 24.05.11 160 253 09.08.11 136 180 05.09.11 166 285 13.01.12 220 301 08.05.12 235 342 13.08.12 161 252
OLD RECORDS
OLD RECORDS
OLD RECORDS
OLD RECORDS
UNDERWENT RX
UNDERWENT RX
INVESTIGATIONS DONE ECG
• USG ABDOMEN
PLAN • MASTER HEALTH CHECKUP OF BLOOD AND URINE
REPORTS
REPEAT FBS, PPBS, HbA1C • FBS : 99mg/dl • PPBS : 146mg/dl • HbA1C : 6.3 % • FROM A DIFFERENT STANDARDISED LAB
STILL MORE OLD RECORDS • RECORDS FROM 97 TO 06 - MISSING
• SERUM CORTISOL
DIAGNOSIS • STEROID WITHDRAWAL • HYPOCORTISOLISM • ?DRUG INDUCED DM • GERD • OA R KNEE
Rx GIVEN • T.DEFLAZACORT 6mg • 0-0-1 = 1 MONTH • 0-0-½ = 1 MONTH • ½ ONCE IN 2 DAYS= 1 MONTH • T.METFORMIN 500mg • 1-0-0 • PPIs • VIT D3 • ALA+BT+MC • T.LIBRIUM 10mg • 0-0-1(SOS)
REPORT
QUESTION • IN THE BEGINNING PT TOOK ONLY METFORMIN FOR > 8 YRS • WHEATHER THE Pt IS HAVING DM? WEATHER WE NEED TO TREAT IT OR NOT? • EVEN THOUGH THE S.CORTISOL IS BECOME NORMAL ONCE I STOPPED THE STEROID Pt HAD SAME COMPLAINTS BUT LESS INTENSITY. • WAT ELSE WE CAN DO FOR THIS Pt?
PRESENTATION - KASTHURI1.pptx

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PRESENTATION - KASTHURI1.pptx

  • 2. DISCUSSION • NAME : KASTHURI • AGE : 67 • SEX : FEMALE • THIN BUILT • KNOWN CASE OF T2DM / SHT / POLYARTHRITIS / FUNCTIONAL PSYCHOSIS • ON REGULAR TREATMENT FOR DM FOR THE PAST 15 YEARS • VEGETARIAN , NOT A SMOKER, ALCOHOLIC, TOBACCO CHEWER
  • 3. COMPLAINTS • DECREASED INTAKE OF FOOD • VOMITING ON AND OFF FOR ONE • GENERALISED WEAKNESS MONTH • IRRELEVENT TALKS ON AND OFF • H/O WITHDRAWAL OF ALL DRUGS FOR MORE THAN ONE MONTH
  • 4. HISTORY • SHE DIAGNOSED AS T2DM IN 1997 WHILE SHE WENT FOR AN EYE CHECK UP. • HER PARENTS DETAILS ABOUT DM IS NA • HER HUSBAND IS DIABETIC • HAVING TWO SONS AND THREE DAUGHTERS. IN THAT, EXCEPT ONE LAST SON, ALL ARE DIABETIC • SHE UNDERWENT CATERACT SURGERY BEFORE 4 YRS FOR ONE EYE AND 1YR FOR ANOTHER EYE. • VERY REGULAR Pt.
  • 5. OLD RECORDS DATE FBS PPBS 15.11.08 140 221 0912.08 110 242 09.01.09 144 176 19.01.09 284 378 19.02.09 186 320 20.03.09 134 169 21.04.09 112 221 21.05.09 134 241 20.06.09 132 160 22.10.09 142 248 08.06.10` 212 282 09.12.10 164 217 24.05.11 160 253 09.08.11 136 180 05.09.11 166 285 13.01.12 220 301 08.05.12 235 342 13.08.12 161 252
  • 13.
  • 15. PLAN • MASTER HEALTH CHECKUP OF BLOOD AND URINE
  • 17.
  • 18.
  • 19. REPEAT FBS, PPBS, HbA1C • FBS : 99mg/dl • PPBS : 146mg/dl • HbA1C : 6.3 % • FROM A DIFFERENT STANDARDISED LAB
  • 20. STILL MORE OLD RECORDS • RECORDS FROM 97 TO 06 - MISSING
  • 21.
  • 23. DIAGNOSIS • STEROID WITHDRAWAL • HYPOCORTISOLISM • ?DRUG INDUCED DM • GERD • OA R KNEE
  • 24. Rx GIVEN • T.DEFLAZACORT 6mg • 0-0-1 = 1 MONTH • 0-0-½ = 1 MONTH • ½ ONCE IN 2 DAYS= 1 MONTH • T.METFORMIN 500mg • 1-0-0 • PPIs • VIT D3 • ALA+BT+MC • T.LIBRIUM 10mg • 0-0-1(SOS)
  • 26.
  • 27. QUESTION • IN THE BEGINNING PT TOOK ONLY METFORMIN FOR > 8 YRS • WHEATHER THE Pt IS HAVING DM? WEATHER WE NEED TO TREAT IT OR NOT? • EVEN THOUGH THE S.CORTISOL IS BECOME NORMAL ONCE I STOPPED THE STEROID Pt HAD SAME COMPLAINTS BUT LESS INTENSITY. • WAT ELSE WE CAN DO FOR THIS Pt?