55 year old male came to the opd with chief  complaints of fever since -4days 

Loss of appetite since 4days 

Unresponsiveness(stupor) 2 hrs before admission

 History of present illness : patient was apparently asymptotic 1 month back  then 

 He came with CVA to  causality at 8:30pm on 20/7/21 with in state of unresponsiveness with GCS e1v1m1 since 2hrs 

Attenders gave h/o fever since 4days , loss of appetite since 4days ,h/o 2 episodes of vomiting (black coloured) 4 days back ,h/o blood in urine 2 weeks back after removal of foleys .

No history of headache , seizures 

No h/o cough , cold 

No other complaints 

Patient continued to take OHA inspire of not eating food .

History of past illness :

 k/c/o T2 DM since 10 months  ( glimi 2mg +metformin 500mg  voglibose 0.2 mg 

Denovo HTN detected 1 month back (telma 40mg OD )

Personal history : 

Married 

Appetite :decreased 

Non vegetarian 

Bowels :irregular 

Micturition :normal 

Family history:  

No similar complaints in the family 

General physical examination: 

Pallor :no 

Icterus ;no 

Cyanosis : no 

Clubbing of fingers :no 

Lymphadenopathy:no 

Oedema of feet :no 

Malnutrition:no 

Vitals :

Temp:102•F 

PR:150 /min 

RR:28 /min 

BP: 180/110mmhg 

Spo2 :97%at room air 

GRBS : 13 mg%

Systemic examination :

CVS : 

S1, S2 heard 

No cardiac murmurs 

Respiratory system :

Position of trachea : central 

Breath sounds :vesicular 

Abdomen :

NAD 

CNS : 

Level of consciousness : stuporous 

Speech :no response 

No signs of meningeal irritation 

GCS : E1V1 M1 

Reflexes : unelicitable 

Provisional diagnosis: 

Altered sensorium 2•to hypoglycemia (OHA induced sulfonyl urea ) 

Left CVA since 1 month 

K/c/o HTN and DM 2 


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