I am Saranya ,a final
year MBBS student.
Greetings to all my
readers;
This is an elog
documenting the patients that I witness during my Clinical Postings to enforce
a greater patient centered learning .
DEIDENTIFICATION :
The privacy of the
patient is being entirely conserved. No identifiers shall be revealed through
out the piece of work whatsoever.
Introduction :
Here we shall discuss
about a lady who is a 57 year old homemaker hailing from India .
PRESENTING
PICTURE OF THE PATIENT :
56 year old female who is a house wife by occupation , survived with one kid
Patient was apparently asymptomatic 21 years back, in 1990 she had one miscarriage and couldn’t conceive till 9 years. In 1999 she had her first child .
No history of any medications for 9 years .
In 2003, had loose stools and vomitings and went to a near by hospital , didn’t subside on medication and she was taken to CMC vellore
Her complaints subsided , where she was diagnosed with right ectopic kidney , hypothyroidism and hypertension was on thyronorm 50mcg and tab.Telma 40mg.
Regular follow up to CMC 2006, 2009, 2013 no complaints .
In 2016, patient had recurrent loose stools for 2 months , and one episode of seizure was taken to hospital , where on connecting monitor showed flat line CPR was initiated, she was revived after 7 cycles ,and she was having bradycardia and was put on temporary pacemaker , and was also diagnosed with IBS
After follow up , she stopped her anti epileptic medications.
She had similar GE symptoms in between subsided on medication.
In august ‘2021 patient had history of low grade fever for 3 days followed by generalised weakness, loss of appetite and was admitted in hospital , where her bp was not recordable and was ionotropes and was diagnosed with pneumonia , septic shock , heart failure with reduced ejection fraction 35% ; patient was on mechanical ventilator for 2 days , indication : low sats as per the attender , cortisol levels where low on test , and MRI was done showing empty Sella ( pan hypopitutarism) and was started on wysolone 5mg . Hospital stay : 20 days , on ventilator for 2 days and ionotropes for 7 days , before her day of discharge , patient had recurrent hypoglycaemic episodes , was put on 25% dextrose .
She was discharged after 20 days.
On discharge Patient attenders observed she was drowsy and they thought due to her medications , she was drowsy for next 2 days , she was taken to the hospital and diagnosed with hyponatremia , was on medication for 2 days , attender observed she had irrelevant talk and self smile psychiatry referral was done diagnosed with schizophrenia .
She was discharged after 4 days
After 1 week patient complained of head ache and on checking her bp was 210/160mmhg
Where she was admitted for 4 days and got discharged.
TIMELINE OF EVENTS
Courtesy declaration: The following images are not original and have been taken for reference from the below mentioned source .
Source : Davidson's Principles and Practice of Medicine
23rd Edition
Update : 3rd December 2021
TREATMENT
