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-   -   Hyperglycemia (https://www.askmehelpdesk.com/showthread.php?t=43557)

  • Nov 18, 2006, 08:18 AM
    crkp
    hyperglycemia
    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
  • Nov 18, 2006, 08:24 AM
    J_9
    Is this homework? I am doing something very similar at this exact moment.

    If this is, what are your thoughts on this case?
  • Nov 18, 2006, 08:40 AM
    crkp
    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
  • Nov 18, 2006, 08:49 AM
    J_9
    Very likely, but why do you think that? Are all of her labs WNLs? What about the WBC, is that WNL?
  • Nov 18, 2006, 09:01 AM
    crkp
    WBC are high which suggest an infection
    But hyperglycemia may falsely increase WBC
  • Nov 18, 2006, 09:07 AM
    J_9
    I was not sure because you are using metric and I am using American, so I was guessing there.
  • Nov 18, 2006, 09:08 AM
    J_9
    What contraindications does your drug book give regarding your 2 meds?

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