PATIENT NAME: S. H. AGE: 67 y.o
ALLERGY: NKDAA GENDRE: F.
HEIGHT: ~153cm WEIGHT: ~55kg


CHIEF COMPLAINT:
Patient passed out.


HISTORY OF PRESENT ILLNESS:
The patient started feeling hyperglycaemic symptoms and passed out.


PAST MEDICAL HISTORY:
1- DM-II for 30 years 2° retinopathy, 2° Nephropathy = ESRD, 2° anemia, 2° HTN

2- CAD  s/p CABG in year 2000, 2° Heart failure (mild LV impairement)

3- Dyslipidemia


FAMILY & SOCIAL HISTORY:
Unknown family history?

Patient is a non-smoker, non-alcoholic


PHYSICAL EXAMINATION:

Vital Signs Day 1 Day 3
BP 140/90 150/65
PP 96 bpm 83-100 bpm
RR 18 breath/mn 18-22 breath/mn
Temp. 36,9° C 36° C – 37° C

REVIEW OF SYSTEMS:

General appearance: pale, have difficulty in speaking, conscious, cooperative, oriented x3

Neurological: slurred speech

RADIOLOGICAL FINDINGS:

CT showed an old infarct
CxR showed mild congestion + cardiomegaly

LABORATORY TESTS:

TESTS 14/09/2004
WBC 13800
RBC 3.37
Hb 10
Hct 30
PLT 160 000
MCV 87
%NEUTR. 89% SEG
%MONO 1%
%EOS 1%
%LYMPH 8%
Na+ 133
K+ 4.3
INR 0.9
BUN 43
Cr 3.2

URINE ANALYSIS:
PH= 7
SG= 1.010
Protein= 3+
Glucose= 1+
Ketones= trace
Hb= +1

DRUG DOSE

1. lantus (glargine) 20 units SQ qpm
2. eprex (epoeitin α)
Eprex 10 000 U SQ qweek
3. losec (omeprazole) 40 mg IVD bid
4. tenormine (atenolol) 25mg po qd
5. Zocor (simvastatin) 20mg po qhs
6. trihemic
(vitc,B12, 115 mg as Fe Fum, VitE, IF, Doc.Na…) 1 tab po qd
7. venofer (100mg as iron sucrose) 1 ampoule qweek after dialysis
8. becozym
(vitamin B+Ca) 1 ampoule IVD
9. baby aspirin 100 mg po qd


please I need to know what's going on with this patient and how to manage her case

Is this homework? I am doing something very similar at this exact moment.

If this is, what are your thoughts on this case?

PATIENT NAME: S. H. AGE: 67 y.o
ALLERGY: NKDAA GENDRE: F.
HEIGHT: ~153cm WEIGHT: ~55kg


CHIEF COMPLAINT:
Patient passed out.


HISTORY OF PRESENT ILLNESS:
The patient started feeling hyperglycaemic symptoms and passed out.


PAST MEDICAL HISTORY:
1- DM-II for 30 years 2° retinopathy, 2° Nephropathy = ESRD, 2° anemia, 2° HTN

2- CAD  s/p CABG in year 2000, 2° Heart failure (mild LV impairement)

3- Dyslipidemia


FAMILY & SOCIAL HISTORY:
Unknown family history?

Patient is a non-smoker, non-alcoholic


PHYSICAL EXAMINATION:

Vital Signs Day 1 Day 3
BP 140/90 150/65
PP 96 bpm 83-100 bpm
RR 18 breath/mn 18-22 breath/mn
Temp. 36,9° C 36° C – 37° C

REVIEW OF SYSTEMS:

General appearance: pale, have difficulty in speaking, conscious, cooperative, oriented x3

Neurological: slurred speech

RADIOLOGICAL FINDINGS:

CT showed an old infarct
CxR showed mild congestion + cardiomegaly

LABORATORY TESTS:

TESTS 14/09/2004
WBC 13800
RBC 3.37
Hb 10
Hct 30
PLT 160 000
MCV 87
%NEUTR. 89% SEG
%MONO 1%
%EOS 1%
%LYMPH 8%
Na+ 133
K+ 4.3
INR 0.9
BUN 43
Cr 3.2

URINE ANALYSIS:
PH= 7
SG= 1.010
Protein= 3+
Glucose= 1+
Ketones= trace
Hb= +1

DRUG DOSE

1. lantus (glargine) 20 units SQ qpm
2. eprex (epoeitin α)
Eprex 10 000 U SQ qweek
3. losec (omeprazole) 40 mg IVD bid
4. tenormine (atenolol) 25mg po qd
5. Zocor (simvastatin) 20mg po qhs
6. trihemic
(vitc,B12, 115 mg as Fe Fum, VitE, IF, Doc.Na…) 1 tab po qd
7. venofer (100mg as iron sucrose) 1 ampoule qweek after dialysis
8. becozym
(vitamin B+Ca) 1 ampoule IVD
9. baby aspirin 100 mg po qd


I think there is interaction between atenolol and lantus causing this hyperglycemia an we should switch to an ACE inhibitor.please help me urgently

Very likely, but why do you think that? Are all of her labs WNLs? What about the WBC, is that WNL?

WBC are high which suggest an infection
But hyperglycemia may falsely increase WBC

I was not sure because you are using metric and I am using American, so I was guessing there.

What contraindications does your drug book give regarding your 2 meds?