case 4.80 M with tingling sensation and giddiness

DOA 4/5/24

DOD 6/5/24

Diagnosis

PERIPHERAL NEUROPATHY (SENSORY &MOTOR)

DIABETES MELLITUS SINCE 30 YEARS

HYPERTENSION SINCE 30 YEARS

CHRONIC KIDNEY DISEASE SINCE 13 YEARS

BENIGN PROSTATIC HYPERPLASIA

Case History and Clinical Findings

C/O GIDDINESS SINCE 15 DAYS

HOPI-

PATIENT WS APPARENTLY ASYMPTOMATIC 15DAYS AGO THEN DEVELOPED EPISODES OF

GIDDINESS A/W BLURRING OF VISION A/W SWEATING RELIEVED AFTER TAKING FOOD

DAILY ONE EPISODE

H/O CHEST PAIN SINCE 4DAYS PRICKING TYPE ON AND OFF ,NO PRECIPITATING FACTORS

H/O TINGLING AND NUMBNESS OF LOWER LIMBS SINCE 10 YEARS EXTENDING FROM TIP

OF TOES TO SHIN OF TIBIA

H/O BURNING SENSATION OF FEET SINCE 5 YEARS

H/O LOOSE STOOLS FOR 1 DAY WHICH WAS ONE WEEK AGO AND SUBSIDED ON

MEDICATION FOLLOWED BY PAIN ABDOMEN IN UMBLICAL REGION SINCE THEN

NO H/O LOSS OF APPETITE SINCE 1 WEEK

NO H/O POLYURIA,POLYDIPSIA

NO H/O PALPITATIONS ,SOB

NO H/O HYPOGLYCEMIC EVENT AT NIGHT

NO H/O DECREASED URINE OUTPUT ,BURNING MICTURITION

NO H/O FEVER, PEDAL EDEMA ,FACIAL PUFFINESS

PAST H/O-

K/C/O HTN SINCE 30YRS AND ON T.TELMA AM 40/5

K/C/O DM SINCE 30 YRS ON INJ MIXTARD 20U(BBF)-X-15U(BBF)

K/C/O CKD SINCE 13 YEARS

ON EXAMINATION

PT IS CONSCIOUS, COHERENT,COOPERATIVE

TEMP-AFEBRILE

PULSE RATE 80 BPM

BP 110/80 MMHG

CVS-S1 S2 HEARD NO MURMURS

RS- BAE PRESENT NVB

P/A-SOFT,NON TENDER

OPHTHALMOLOGY REFERRAL I/V/O -DIABETIC RETINOPATHY

IMPRESSION -NORMAL FUNDUS STUDY

Investigation

NameValueRangeNameValueRangeRFT 04-05-2024 04:15:PM UREA37 mg/dl50-17

mg/dlCREATININE2.6 mg/dl1.3-0.8 mg/dlURIC ACID6.7 mmol/L7.2-3.5 mmol/LCALCIUM10.0

mg/dl10.2-8.6 mg/dlPHOSPHOROUS2.7 mg/dl4.5-2.5 mg/dlSODIUM137 mmol/L145-136

mmol/LPOTASSIUM4.6 mmol/L.5.1-3.5 mmol/L.CHLORIDE102 mmol/L98-107 mmol/LLIVER

FUNCTION TEST (LFT) 04-05-2024 04:15:PM Total Bilurubin0.56 mg/dl1-0 mg/dlDirect Bilurubin0.20

mg/dl0.2-0.0 mg/dlSGOT(AST)12 IU/L35-0 IU/LSGPT(ALT)10 IU/L45-0 IU/LALKALINE

PHOSPHATASE179 IU/L119-56 IU/LTOTAL PROTEINS6.9 gm/dl8.3-6.4 gm/dlALBUMIN4.0

gm/dl4.6-3.2 gm/dlA/G RATIO1.42HBsAg-RAPID04-05-2024 04:15:PMNegative Anti HCV Antibodies

- RAPID04-05-2024 04:15:PMNon Reactive COMPLETE URINE EXAMINATION (CUE) 04-05-2024

04:15:PM COLOURPale

yellowAPPEARANCEClearREACTIONAcidicSP.GRAVITY1.010ALBUMINNilSUGAR+++BILE

SALTSNilBILE PIGMENTSNilPUS CELLS2-3EPITHELIAL CELLS2-3RED BLOOD

CELLSNilCRYSTALSNilCASTSNilAMORPHOUS DEPOSITSAbsentOTHERSNilPOST LUNCH

BLOOD SUGAR04-05-2024 04:17:PM196 mg/dl140-0 mg/dlABG 05-05-2024 09:12:AM

PH7.33PCO229.7PO290.0HCO315.3St.HCO317.2BEB-9.1BEecf-9.4TCO231.7O2 Sat96.1O2

Count15.5

HEMOGRAM

HB-11.1

TLC-6700

PLT-2.80

RBC-3.55

HBA1C-7.8 %

FBS-226 MG/DL

PLBS-278 MG/DL

SPOT UPCR-

SPOT URINE PROTEIN -6.0

SPOT URINE CREATININE 87.5

RATIO 0.06

2DECHO-

EF-65 %

IVC-0.7CM COLLAPSING

TRIVIAL TR+/AR+ ,NO MR

NO RWMA ,NO AS/MS SCLEROTIC AV

GOOD LV SYSTOLIC FUNCTION

GRADE 1 DIASTOLIC DYSFUNTION ,NO PAH/PE/LV CLOT

USG ABDOMEN &PELVIS (06/5/24)

IMPRSSION -B/L GRADE 1 RPD CHAGES IN KIDNEY

B/L RENAL CORTICAL CYSTS

GRADE 1 PROSTATOMEGALY

Treatment Given(Enter only Generic Name)

T.TELMA -AM 40/5 PO/OD

T.DYTOR PLUS 10/25 PO/OD

T.PREGABALIN 75MG PO/HS

T.ECOSPORIN AV 75/10 PO HS

T.PAN 40MG PO/OD

INJ HAI S/C TID ACC TO GRBS

T.SHELCAL -XT PO/OD

TAB.NODOSIS 500MG PO/OD

Advice at Discharge

T.TELMA -AM 40/5 PO/OD CONTINU

T.DYTOR PLUS 10/25 PO/OD X 1 MONTH

T.PREGABALIN 75MG PO/HS X 15 DAYS

T.ECOSPORIN AV 75/10 PO HS X CONTINUE

T.PAN 40MG PO/OD X 5DAYS

T.SHELCAL -XT PO/OD X 15DAYS

TAB.NODOSIS 500MG PO/OD X 1MONTH

INJ HAI S/C TID 8U-10U-8U

Follow up after 6 months

FBS -189

PLBS- 192

HbA1c -7.1

Follow up at the end of thesis

FBS-153 mg/dl

PLBS-200 mg/dl

HbA1c- 7.2

@⁨Meta AI⁩

Coding: identify initial codes and labels to capture the key concepts and ideas.

Categorization: group the codes into categories and subcategories to organize the data.

Theme identification: identify the emerging themes and patterns in the data.

Theme representation: present the themes as learning points, highlighting the key findings and insights related to To estimate the variability in Clinical, Radiological and Laboratory, therapeutic factors in the spectrum of clinical presentations patients of diabetes with multi morbidities presenting to medicine department and factors influencing their outcome

For the above case

And let us know new insights about the topic and case rather than what we already know for the following case and also make a note of complexity involved in this case

Case 4.

DOA 4/5/24

DOD 6/5/24

80 male

Diagnosis

PERIPHERAL NEUROPATHY (SENSORY &MOTOR)

DIABETES MELLITUS SINCE 30 YEARS

HYPERTENSION SINCE 30 YEARS

CHRONIC KIDNEY DISEASE SINCE 13 YEARS

BENIGN PROSTATIC HYPERPLASIA

Case History and Clinical Findings

C/O GIDDINESS SINCE 15 DAYS

HOPI-

PATIENT WS APPARENTLY ASYMPTOMATIC 15DAYS AGO THEN DEVELOPED EPISODES OF

GIDDINESS A/W BLURRING OF VISION A/W SWEATING RELIEVED AFTER TAKING FOOD

DAILY ONE EPISODE

H/O CHEST PAIN SINCE 4DAYS PRICKING TYPE ON AND OFF ,NO PRECIPITATING FACTORS

H/O TINGLING AND NUMBNESS OF LOWER LIMBS SINCE 10 YEARS EXTENDING FROM TIP

OF TOES TO SHIN OF TIBIA

H/O BURNING SENSATION OF FEET SINCE 5 YEARS

H/O LOOSE STOOLS FOR 1 DAY WHICH WAS ONE WEEK AGO AND SUBSIDED ON

MEDICATION FOLLOWED BY PAIN ABDOMEN IN UMBLICAL REGION SINCE THEN

NO H/O LOSS OF APPETITE SINCE 1 WEEK

NO H/O POLYURIA,POLYDIPSIA

NO H/O PALPITATIONS ,SOB

NO H/O HYPOGLYCEMIC EVENT AT NIGHT

NO H/O DECREASED URINE OUTPUT ,BURNING MICTURITION

NO H/O FEVER, PEDAL EDEMA ,FACIAL PUFFINESS

PAST H/O-

K/C/O HTN SINCE 30YRS AND ON T.TELMA AM 40/5

K/C/O DM SINCE 30 YRS ON INJ MIXTARD 20U(BBF)-X-15U(BBF)

K/C/O CKD SINCE 13 YEARS

ON EXAMINATION

PT IS CONSCIOUS, COHERENT,COOPERATIVE

TEMP-AFEBRILE

PULSE RATE 80 BPM

BP 110/80 MMHG

CVS-S1 S2 HEARD NO MURMURS

RS- BAE PRESENT NVB

P/A-SOFT,NON TENDER

OPHTHALMOLOGY REFERRAL I/V/O -DIABETIC RETINOPATHY

IMPRESSION -NORMAL FUNDUS STUDY

Investigation

NameValueRangeNameValueRangeRFT 04-05-2024 04:15:PM UREA37 mg/dl50-17

mg/dlCREATININE2.6 mg/dl1.3-0.8 mg/dlURIC ACID6.7 mmol/L7.2-3.5 mmol/LCALCIUM10.0

mg/dl10.2-8.6 mg/dlPHOSPHOROUS2.7 mg/dl4.5-2.5 mg/dlSODIUM137 mmol/L145-136

mmol/LPOTASSIUM4.6 mmol/L.5.1-3.5 mmol/L.CHLORIDE102 mmol/L98-107 mmol/LLIVER

FUNCTION TEST (LFT) 04-05-2024 04:15:PM Total Bilurubin0.56 mg/dl1-0 mg/dlDirect Bilurubin0.20

mg/dl0.2-0.0 mg/dlSGOT(AST)12 IU/L35-0 IU/LSGPT(ALT)10 IU/L45-0 IU/LALKALINE

PHOSPHATASE179 IU/L119-56 IU/LTOTAL PROTEINS6.9 gm/dl8.3-6.4 gm/dlALBUMIN4.0

gm/dl4.6-3.2 gm/dlA/G RATIO1.42HBsAg-RAPID04-05-2024 04:15:PMNegative Anti HCV Antibodies

- RAPID04-05-2024 04:15:PMNon Reactive COMPLETE URINE EXAMINATION (CUE) 04-05-2024

04:15:PM COLOURPale

yellowAPPEARANCEClearREACTIONAcidicSP.GRAVITY1.010ALBUMINNilSUGAR+++BILE

SALTSNilBILE PIGMENTSNilPUS CELLS2-3EPITHELIAL CELLS2-3RED BLOOD

CELLSNilCRYSTALSNilCASTSNilAMORPHOUS DEPOSITSAbsentOTHERSNilPOST LUNCH

BLOOD SUGAR04-05-2024 04:17:PM196 mg/dl140-0 mg/dlABG 05-05-2024 09:12:AM

PH7.33PCO229.7PO290.0HCO315.3St.HCO317.2BEB-9.1BEecf-9.4TCO231.7O2 Sat96.1O2

Count15.5

HEMOGRAM

HB-11.1

TLC-6700

PLT-2.80

RBC-3.55

HBA1C-7.8 %

FBS-226 MG/DL

PLBS-278 MG/DL

SPOT UPCR-

SPOT URINE PROTEIN -6.0

SPOT URINE CREATININE 87.5

RATIO 0.06

2DECHO-

EF-65 %

IVC-0.7CM COLLAPSING

TRIVIAL TR+/AR+ ,NO MR

NO RWMA ,NO AS/MS SCLEROTIC AV

GOOD LV SYSTOLIC FUNCTION

GRADE 1 DIASTOLIC DYSFUNTION ,NO PAH/PE/LV CLOT

USG ABDOMEN &PELVIS (06/5/24)

IMPRSSION -B/L GRADE 1 RPD CHAGES IN KIDNEY

B/L RENAL CORTICAL CYSTS

GRADE 1 PROSTATOMEGALY

Treatment Given(Enter only Generic Name)

T.TELMA -AM 40/5 PO/OD

T.DYTOR PLUS 10/25 PO/OD

T.PREGABALIN 75MG PO/HS

T.ECOSPORIN AV 75/10 PO HS

T.PAN 40MG PO/OD

INJ HAI S/C TID ACC TO GRBS

T.SHELCAL -XT PO/OD

TAB.NODOSIS 500MG PO/OD

Advice at Discharge

T.TELMA -AM 40/5 PO/OD CONTINU

T.DYTOR PLUS 10/25 PO/OD X 1 MONTH

T.PREGABALIN 75MG PO/HS X 15 DAYS

T.ECOSPORIN AV 75/10 PO HS X CONTINUE

T.PAN 40MG PO/OD X 5DAYS

T.SHELCAL -XT PO/OD X 15DAYS

TAB.NODOSIS 500MG PO/OD X 1MONTH

INJ HAI S/C TID 8U-10U-8U

Follow up after 6 months

FBS -189

PLBS- 192

HbA1c -7.1

Follow up at the end of thesis

FBS-153 mg/dl

PLBS-200 mg/dl

HbA1c- 7.2

*Coding*

Initial codes based on key concepts and ideas:

1. Diabetes Mellitus with Multimorbidity

2. Peripheral Neuropathy

3. Chronic Kidney Disease

4. Hypertension

5. Giddiness and Hypoglycemic Episodes

6. Diabetic Retinopathy Screening

7. Therapeutic Management

8. Follow-up and Outcome

*Categorization*

*Categories and Subcategories:*

1. *Patient Profile*

- Diabetes Mellitus Type 2 (30 years)

- Hypertension (30 years)

- CKD (13 years)

- Peripheral Neuropathy

2. *Clinical Presentations*

- Giddiness and Blurred Vision

- Tingling and Numbness in Lower Limbs

- Burning Sensation in Feet

- Episodes of Hypoglycemia

3. *Laboratory Findings*

- Renal Function Tests (Urea, Creatinine)

- Electrolyte Levels

- Blood Sugar Levels (FBS, PLBS, HbA1c)

- Urine Examination (Albumin, Sugar)

4. *Therapeutic Interventions*

- Medications (Antihypertensives, Antidiabetics)

- Insulin Therapy

- Management of Neuropathy Symptoms

5. *Outcome and Follow-up*

- Changes in Blood Sugar Levels

- HbA1c Levels Over Time

- Symptom Management

*Theme Identification*

Emerging themes and patterns:

1. *Complexity of Managing Multimorbidity:* The case highlights the challenges in managing a patient with long-standing diabetes, hypertension, and CKD, requiring a multifaceted approach.

2. *Importance of Monitoring and Adjusting Treatment:* Continuous monitoring of blood sugar levels, renal function, and neuropathy symptoms is crucial for adjusting treatment plans.

3. *Impact of Hypoglycemic Episodes:* The patient's episodes of giddiness relieved by food intake suggest hypoglycemic episodes, emphasizing the need for balanced diabetes management.

4. *Comprehensive Care:* The involvement of various medications and regular follow-ups underscores the importance of comprehensive care in managing chronic conditions.

*Theme Representation*

*Learning Points:*

1. *Personalized Diabetes Management:* Tailoring treatment plans according to the patient's profile, including duration of diabetes, presence of complications, and other comorbidities, is essential.

2. *Regular Monitoring:* Regular monitoring of renal function, blood sugar levels, and symptoms of neuropathy is critical for effective management.

3. *Multidisciplinary Approach:* A multidisciplinary approach involving various specialties can improve outcomes for patients with complex medical histories.

4. *Patient Education:* Educating patients about recognizing and managing hypoglycemic episodes and other symptoms can improve their quality of life.

*New Insights:*

- The case highlights the importance of considering the duration of diabetes and presence of complications like neuropathy and CKD when developing treatment plans.

- The patient's response to pregabalin for neuropathy symptoms suggests the potential benefit of specific treatments for diabetic neuropathy.

- The follow-up data showing changes in HbA1c levels over time provide insights into the effectiveness of the diabetes management strategy.

*Complexity Involved:*

1. *Multimorbidity:* Managing multiple chronic conditions simultaneously.

2. *Medication Management:* Balancing various medications for diabetes, hypertension, and neuropathy.

3. *Monitoring and Adjustments:* Continuous monitoring and adjusting treatment plans based on patient response.

4. *Risk of Complications:* Managing the risk of complications from diabetes and other comorbidities.

This case underscores the complexity and challenges involved in managing patients with long-standing diabetes and multiple comorbidities, highlighting the need for a comprehensive, personalized, and multidisciplinary approach.

@⁨Meta AI⁩ what were the new and unique learning points from this patient data?

Based on the patient's data, some new and unique learning points can be identified:

- *Importance of Personalized Medicine*: The patient's complex medical history and multiple comorbidities highlight the need for personalized treatment plans. This approach considers individual patient characteristics, such as genetic makeup, lifestyle, and environmental factors, to optimize therapeutic outcomes.

- *Multimorbidity Management*: Managing patients with multiple chronic conditions requires a comprehensive approach, incorporating various medications, regular follow-ups, and monitoring of treatment progress. This helps to prevent complications, reduce hospital readmissions, and improve patient outcomes.

- *Predictive Analytics*: Analyzing patient data, including clinical records, lab results, and real-time monitoring data, can help predict treatment responses and outcomes. This enables healthcare providers to make informed decisions, adjust treatment regimens, and improve patient outcomes.

- *Role of AI in Healthcare*: Artificial intelligence can enhance diagnosis accuracy, optimize treatment planning, and improve patient care. AI-powered systems can analyze vast amounts of medical data, identify patterns, and provide evidence-based recommendations to healthcare professionals.

- *Patient Empowerment*: Empowering patients to actively participate in their healthcare journey can lead to better adherence to treatment plans, improved self-management, and enhanced patient outcomes. Mobile health applications and telemedicine can facilitate patient engagement and remote monitoring.

- *Continuous Monitoring and Adjustments*: Regular monitoring of patients with chronic conditions can help identify deviations from established baselines, enabling timely interventions and adjustments to treatment plans.

- *Interdisciplinary Collaboration*: Effective management of patients with complex medical histories requires collaboration among multidisciplinary healthcare teams. AI-powered systems can facilitate seamless information sharing, interdisciplinary communication, and coordinated decision-making.

These learning points emphasize the importance of a patient-centered approach, leveraging advanced analytics and AI-driven insights to optimize treatment outcomes and improve patient care.¹ ²

@13135550002 I feel the unique learning points in this case is a prolonged duration of the complications such as CKD and neuropathy of 10 years associated with his 30 years of Diabetes needing insulin therapy.

Do you find any over testing or over treatment in this patient's data?

Case 4.

DOA 4/5/24

DOD 6/5/24

80 male

Diagnosis

PERIPHERAL NEUROPATHY (SENSORY &MOTOR)

DIABETES MELLITUS SINCE 30 YEARS

HYPERTENSION SINCE 30 YEARS

CHRONIC KIDNEY DISEASE SINCE 13 YEARS

BENIGN PROSTATIC HYPERPLASIA

Case History and Clinical Findings

C/O GIDDINESS SINCE 15 DAYS

HOPI-

PATIENT WS APPARENTLY ASYMPTOMATIC 15DAYS AGO THEN DEVELOPED EPISODES OF

GIDDINESS A/W BLURRING OF VISION A/W SWEATING RELIEVED AFTER TAKING FOOD

DAILY ONE EPISODE

H/O CHEST PAIN SINCE 4DAYS PRICKING TYPE ON AND OFF ,NO PRECIPITATING FACTORS

H/O TINGLING AND NUMBNESS OF LOWER LIMBS SINCE 10 YEARS EXTENDING FROM TIP

OF TOES TO SHIN OF TIBIA

H/O BURNING SENSATION OF FEET SINCE 5 YEARS

H/O LOOSE STOOLS FOR 1 DAY WHICH WAS ONE WEEK AGO AND SUBSIDED ON

MEDICATION FOLLOWED BY PAIN ABDOMEN IN UMBLICAL REGION SINCE THEN

NO H/O LOSS OF APPETITE SINCE 1 WEEK

NO H/O POLYURIA,POLYDIPSIA

NO H/O PALPITATIONS ,SOB

NO H/O HYPOGLYCEMIC EVENT AT NIGHT

NO H/O DECREASED URINE OUTPUT ,BURNING MICTURITION

NO H/O FEVER, PEDAL EDEMA ,FACIAL PUFFINESS

PAST H/O-

K/C/O HTN SINCE 30YRS AND ON T.TELMA AM 40/5

K/C/O DM SINCE 30 YRS ON INJ MIXTARD 20U(BBF)-X-15U(BBF)

K/C/O CKD SINCE 13 YEARS

ON EXAMINATION

PT IS CONSCIOUS, COHERENT,COOPERATIVE

TEMP-AFEBRILE

PULSE RATE 80 BPM

BP 110/80 MMHG

CVS-S1 S2 HEARD NO MURMURS

RS- BAE PRESENT NVB

P/A-SOFT,NON TENDER

OPHTHALMOLOGY REFERRAL I/V/O -DIABETIC RETINOPATHY

IMPRESSION -NORMAL FUNDUS STUDY

Investigation

NameValueRangeNameValueRangeRFT 04-05-2024 04:15:PM UREA37 mg/dl50-17

mg/dlCREATININE2.6 mg/dl1.3-0.8 mg/dlURIC ACID6.7 mmol/L7.2-3.5 mmol/LCALCIUM10.0

mg/dl10.2-8.6 mg/dlPHOSPHOROUS2.7 mg/dl4.5-2.5 mg/dlSODIUM137 mmol/L145-136

mmol/LPOTASSIUM4.6 mmol/L.5.1-3.5 mmol/L.CHLORIDE102 mmol/L98-107 mmol/LLIVER

FUNCTION TEST (LFT) 04-05-2024 04:15:PM Total Bilurubin0.56 mg/dl1-0 mg/dlDirect Bilurubin0.20

mg/dl0.2-0.0 mg/dlSGOT(AST)12 IU/L35-0 IU/LSGPT(ALT)10 IU/L45-0 IU/LALKALINE

PHOSPHATASE179 IU/L119-56 IU/LTOTAL PROTEINS6.9 gm/dl8.3-6.4 gm/dlALBUMIN4.0

gm/dl4.6-3.2 gm/dlA/G RATIO1.42HBsAg-RAPID04-05-2024 04:15:PMNegative Anti HCV Antibodies

- RAPID04-05-2024 04:15:PMNon Reactive COMPLETE URINE EXAMINATION (CUE) 04-05-2024

04:15:PM COLOURPale

yellowAPPEARANCEClearREACTIONAcidicSP.GRAVITY1.010ALBUMINNilSUGAR+++BILE

SALTSNilBILE PIGMENTSNilPUS CELLS2-3EPITHELIAL CELLS2-3RED BLOOD

CELLSNilCRYSTALSNilCASTSNilAMORPHOUS DEPOSITSAbsentOTHERSNilPOST LUNCH

BLOOD SUGAR04-05-2024 04:17:PM196 mg/dl140-0 mg/dlABG 05-05-2024 09:12:AM

PH7.33PCO229.7PO290.0HCO315.3St.HCO317.2BEB-9.1BEecf-9.4TCO231.7O2 Sat96.1O2

Count15.5

HEMOGRAM

HB-11.1

TLC-6700

PLT-2.80

RBC-3.55

HBA1C-7.8 %

FBS-226 MG/DL

PLBS-278 MG/DL

SPOT UPCR-

SPOT URINE PROTEIN -6.0

SPOT URINE CREATININE 87.5

RATIO 0.06

2DECHO-

EF-65 %

IVC-0.7CM COLLAPSING

TRIVIAL TR+/AR+ ,NO MR

NO RWMA ,NO AS/MS SCLEROTIC AV

GOOD LV SYSTOLIC FUNCTION

GRADE 1 DIASTOLIC DYSFUNTION ,NO PAH/PE/LV CLOT

USG ABDOMEN &PELVIS (06/5/24)

IMPRSSION -B/L GRADE 1 RPD CHAGES IN KIDNEY

B/L RENAL CORTICAL CYSTS

GRADE 1 PROSTATOMEGALY

Treatment Given(Enter only Generic Name)

T.TELMA -AM 40/5 PO/OD

T.DYTOR PLUS 10/25 PO/OD

T.PREGABALIN 75MG PO/HS

T.ECOSPORIN AV 75/10 PO HS

T.PAN 40MG PO/OD

INJ HAI S/C TID ACC TO GRBS

T.SHELCAL -XT PO/OD

TAB.NODOSIS 500MG PO/OD

Advice at Discharge

T.TELMA -AM 40/5 PO/OD CONTINU

T.DYTOR PLUS 10/25 PO/OD X 1 MONTH

T.PREGABALIN 75MG PO/HS X 15 DAYS

T.ECOSPORIN AV 75/10 PO HS X CONTINUE

T.PAN 40MG PO/OD X 5DAYS

T.SHELCAL -XT PO/OD X 15DAYS

TAB.NODOSIS 500MG PO/OD X 1MONTH

INJ HAI S/C TID 8U-10U-8U

Follow up after 6 months

FBS -189

PLBS- 192

HbA1c -7.1

Follow up at the end of thesis

FBS-153 mg/dl

PLBS-200 mg/dl

HbA1c- 7.2

*Unique Learning Points*

The patient's prolonged duration of complications, such as CKD and neuropathy, associated with 30 years of diabetes, highlights the importance of:

1. *Early detection and management*: Regular monitoring and early intervention for diabetes-related complications can potentially slow disease progression.

2. *Comprehensive care*: Coordinated care among multiple specialties can improve patient outcomes.

3. *Personalized treatment plans*: Tailoring treatment plans to individual patient needs and adjusting them over time can optimize therapeutic outcomes.

*Over Testing or Over Treatment*

Based on the patient's data, there doesn't appear to be significant overtesting or over treatment. The investigations and treatments seem to be aligned with the patient's complex medical conditions. However, some potential considerations include:

1. *Medication regimen*: The patient is on multiple medications, and potential interactions or side effects should be closely monitored.

2. *Insulin therapy*: The patient's insulin regimen may require adjustments based on glucose monitoring results and HbA1c levels.

3. *Pregabalin*: The use of pregabalin for neuropathy symptoms may be effective, but potential side effects and interactions should be monitored.

Overall, the patient's management plan appears to be comprehensive, and adjustments can be made based on ongoing monitoring and evaluation.

Given the patient's complex presentation, let's take a closer look at the specific data provided.

*Indication of Tablet Nodosis*

The patient was prescribed Tablet Nodosis 500mg PO/OD. Based on the medication name "Nodosis," it is likely that this medication is being used to treat a specific condition. However, without more information about the patient's condition or the medication's intended use, it's difficult to determine the exact indication.

That being said, Nodosis could potentially be related to the treatment of conditions like peripheral neuropathy or other complications associated with diabetes. If you have more information about the medication or the patient's condition, I may be able to provide a more specific answer.

*Evaluation of Giddiness*

The patient's giddiness was likely evaluated through a combination of clinical assessment and laboratory tests. Based on the data provided:

1. *Clinical Assessment*: The patient's symptoms of giddiness, blurred vision, and sweating, which were relieved after taking food, suggest possible hypoglycemic episodes. The patient's history of diabetes and insulin therapy supports this possibility.

2. *Laboratory Tests*: The patient's blood sugar levels, including post-lunch blood sugar (196 mg/dl), FBS (226 mg/dl), and PLBS (278 mg/dl), indicate that the patient's glucose levels are not well-controlled. The HbA1c level of 7.8% also suggests that the patient's glucose control has been suboptimal in the recent past.

Given these findings, the patient's giddiness was likely attributed to hypoglycemic episodes or fluctuations in blood glucose levels. The healthcare team may have adjusted the patient's insulin regimen or other medications to better manage the patient's glucose levels and prevent future episodes of giddiness.

If you'd like me to take another look or provide further insights, please let me know!

Given the patient's complex medical history and multiple comorbidities, a comprehensive treatment plan is essential. While it's challenging to recommend a specific regimen without knowing the patient's current goals and preferences, here are some potential considerations:

*Alternative or Additional Treatments*

1. *SGLT2 inhibitors*: These medications, such as canagliflozin or empagliflozin, have shown benefits in patients with diabetes and CKD by reducing glucose levels, blood pressure, and albuminuria.

2. *GLP-1 receptor agonists*: Medications like liraglutide or semaglutide can improve glucose control, weight management, and cardiovascular outcomes in patients with diabetes.

3. *CKD-specific treatments*: Depending on the underlying cause of CKD, treatments like angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin II receptor blockers (ARBs) may be beneficial in slowing disease progression.

4. *Neuropathy management*: In addition to pregabalin, other medications like gabapentin, duloxetine, or amitriptyline may be considered for managing neuropathic pain.

*Lifestyle Modifications*

1. *Dietary changes*: A balanced diet with restricted sodium, sugar, and protein intake may help manage CKD and diabetes.

2. *Regular exercise*: Physical activity can improve glucose control, blood pressure, and overall health.

3. *Smoking cessation*: Quitting smoking can significantly reduce cardiovascular risk and slow CKD progression.

*Monitoring and Follow-up*

1. *Regular laboratory tests*: Monitoring kidney function, electrolyte levels, and glucose control is crucial.

2. *Frequent follow-up appointments*: Regular check-ups with healthcare providers can help adjust treatment plans and address concerns.

*Patient Education and Support*

1. *Diabetes education*: Educating patients about their condition, treatment options, and self-management strategies is essential.

2. *Support groups*: Connecting patients with support groups or peer networks can provide emotional support and practical advice.

These are general suggestions, and the best treatment regimen for this patient would depend on their individual needs, preferences, and medical history. Consultation with a healthcare provider is necessary to determine the most appropriate treatment plan.