Difficult case on T2Diabetes Management 1 Dr bounmy SOMSAMOUTH Chief of Endocrinology Setthathirath Hospital

History of the Patient A 68 year old Lao women. Chief complaint : confused , and anxiety.

Present illness History Known case T2DM, HTN, CKD. She has had confusion and anxiety 12hr before admitted. The symptom started when she get up in the morning . She had referred to ER She had no history of fever, head ache, cough, or chest pain or body’s weakness. History of drugs use. NPH insulin 10 unit morning ,6unit evening sc/day, Nifedipine 20mg 1 x 2/day, sodamint 1x3,day, fer 1x3, folic 1x1, ketosteril 2x3/d, methycobal 1x3/d, and micera 100mcg sc/month.

Past medical and Family history T2 DM more then 10 year Hypertension >8year and become chronic kidney disease (CKD) 3years, Family history: Older sister and younger sister T2DM , HTN,CKD Young sister died 3year ago.

Physical Examination Vital signs Mental status : Bp150/100mmHg Pulse 90bpm Oxygen 98% Mental status : mild confused, anxiety. Heart, lungs normal and abdominal soft Dorsalis Pedis and posterior tibia pulse: decrease

What differential diagnosis Hypertensive crisis? Cerebral infarction or hemorrhages ? Metabolic imbalance? Hyper glycemia? Hypoglycemia?

Investigation CBC WBC 8,600, neutrophyle 70%, HCT 27%, HGB9,4g/dl Biochemistries: creatinine 2,59mg/dl, cholesterole 200mg/dl, TG 250mg/dl UA protein 2+, glucose 1+, WBC, RBC negative EKG : LVH Electrolyte : sodium 137, k4,5, cl 102, Glucose 57mg/dl

What is final diagnosis? Hypertensive crisis? Cerebral infarction or hemorrhages ? Metabolic disorder? Hyper glycemia? Hypoglycemia?

Presented by Dr bounmy SOMSAMOUTH

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Thank you for your attention