A 47 year old woman, a resident of Nalgonda district , a housemaker was brought to the casualty yesterday with the chief complaints of
Altered sensorium since 4 am yesterday morning , the patients son tells that she has been in an altered state with no vocal response since 4am yesterday.
HOPI:
Patient was apparantly alright and then developed symptoms suggestive of COVID-19 on 4/06/2021 and she was tested positive after which she received LMWH, PIPTAZ , METHYPRED for 5 days. She was diagnosed with DM 25 days ago and her blood sugars were high on admission (600mg/dl) and she was started on human mixtard insulin according to sliding scale since then.
Past history:
Not a known case of htn, cva , cad, tb , bronchial asthma.
Personal history:
married
Diet : mixed
Appetite: normal
Bowel and bladder: regular
Sleep: adequate
No known allergies and no addictions.
Famliy history: not significant
General physical examination:
Temp: afebrile
PR:79bpm
RR:20cpm
On presentation to us,
Her GCS was
E2V2M4
Her GRBS was 390mg/dl
BP was 140/80
Her pupils were reacting to light bilaterally
Her right pupil was dilated
There were no meningeal signs
All her upper limb reflexes were exaggerated
Her lower limb reflexes were absent and plantars were mute
Cvs - S1,S2 +
Lungs - BAE +
INVESTIGATIONS:
HAEMOGRAM:
CUE
Urine for ketone bodies
LFT
ABG
Grbs charting
ECG
MRI
Treatment:
- head end elavation
-O2 supplementation, maintain Spo2-92%
-ryles tube feeding
-IVF: 2 pint NS @75ml/hr with 1 amp Optineuron
-inj. Monocef 1gm/iv/bd
-inj.pantop 40mg/iv/od
-inj. Human actrapid insulin @3ml/hr and taper according to algorithm
-tab. Dolo 650mg po sos
-inj. Neomol100ml iv if temp is >102°F
-inj. Mannitol 100ml/iv/tid
-inj. Acyclovir 800mg/iv/tid
-grbs charting hourly
-monitor vitals and temperature
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