65 yr old women with upper and lower limb weakness

 This is a case of 65 year old female, housewife, staying alone since 5 years presented with cheif complaints of 

Weakness of upper and lower limbs

Difficulty in walking


HOPI

The patient is apparently asymptotic 20 years back 

20 yrs ago

The patient had hyperthyroidism. Kept on Neocarbimazole 5mg Po OD

10 yrs ago

She had decreased APETITE for which she went to local hospital. She was diagnosed to be type 2 DM and was kept on OHA

Since 1 week

She complains of high grade fever associated with chills and rigors

Since 2 days 

Decreased food intake and missed OHAs

Difficulty in walking 

weakness of upper and lower limbs

Passing stools and urine in her clothes 


Past history 

Diabetic since 10 years on Insulin 

Hyperthyroidism since 20 years on neocarbimazole 5mg Po OD

PERSONAL HISTORY 

DIET mixed 

APETITE  decreased 

SLEEP adequate 

BOWEL AND BLADDER MOVEMENTS involuntary 

ADDICTIONS none


FAMILY HISTORY 

Not significant 

GENERAL EXAMINATION 


The patient is coherent conscious cooperative well oriented to time place and person 

She is thin built and moderately nourished 

Pallor absent 

Icterus absent 

Cyanosis absent 

Clubbing absent 

Edema absent

Lymphadenopathy absent 

VITALS 

Pulse 79

BP 120/80

RR 20

Temperature 99.4

Spo2 83%

GRBS 167


SYSTEMIC EXAMINATION 

CVS- S1 S2 heard. No other sounds heard

RS -normal vesicular breath sounds heard

PA- soft and non tender 

CNS- higher motor functions intact 
























Diagnosis 

?Diabetic Keto acidosis 



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