68/F with altered sensorium

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Cheif complaints:
Patient was brought to the casualty with the c/o altered sensorium since 2 days
HOPI:

Patient was apparently asymptomatic 2weeks back then she developed non bilious,non projectile vomitings 5 episodes food particles as a content associated with nausea treated with iv fluids at local hospital.loss of appetite,generalised weakness from 2days,altered sensorium worsened, intermittently gaining Orientation
No h/o fever,loose stools
No h/o constipation
H/o burning micturition
No h/o chest pain, palpitations,sob
No h/o seizures,loss of consciousness and headache.
K/c/o htn since 20 yrs on t.telmisartan 40mg+clinidipine+chlorothiazide 12.5mg
K/c/o dm since 20 yrs on t.glimiperide 1mg +metformin 500mg
O/e:
Patient is drowsy, 
MMSE:
Orientation to time:1
Orientation to place:2
Registration:3
Attention:0
Recall:2
Naming:3
Repeatation:0.5
Read and follow commands:1
Sentence:0.5
Copying:0
Score:13/30

Patient is conscious, but drowsy
Moderately built and nourished.
No signs of pallor, icterus, clubbing, cyanosis, pedal edema and lymphadenopathy.

Vitals:
Temp:98.6F
PR:84bpm
RR:19 cpm
BP:120/70mm.hg
Spo2:99%
GRBS:164mg/dl


SYSTEMIC EXAMINATION:-
Respiratory system:-
Bilateral air entry present 
NVBS heard
Cardiovascular system:-
S1, S2 heard
Abdomen:-
Soft, Non tender
CNS:-
NFND
CNS: 
GCS- E4 V4 M6
Power - 
         Rt. Lt
UL - 4/5 4/5
LL - 4/5 4/5
TONE 
UL - N. N
LL - N. N
Reflexes
B - 2+. 2+
T - 2+. 2+
S- 2+. 2+
K - 2+. 2+
A - 2+ 2+
Clinical images
ELECTROLYTES
26/5 27/5 28/5 29/5
Na+-130 135 140 141
k+- 3.3 3.2 3.5 3.5
cl- 95 98 105 99

Diagnosis
ALTERED SENSORIUM 
?DYSELECTROLYTEMIA



Plan of care


1)IV fluids 0.9%NS@ 50ml/hr
2) Inj. optineuron 1 amp in 100ml NS/IV/OD
3) ARISTOZYME PO/TID
4)Inj.HUMAN ACTRAPID INSULIN S/C TID 
5)Tab. TELMISARTAN 40MG PO/OD 
6) SYP.CREMAFFIN PLUS 15ml/PO/STAT
7) Vitals monitoring 2  hrly
8) GRBS monitoring

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