67 year old male with vomiting, facial swelling and thickened tongue

THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE - IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT .HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUT."

 A 67year old male came to our hospital with chief complaints of vomiting, facial swelling, and thickened tongue.

HOPI: patient was apparently asymptomatic 10 days back then he had episodes of vomiting. The vomited material was watery with food particles. Then he developed facial swelling and thickening of tongue. He went to local doctor with same complaints and received medication. The symptoms were reduced but the episodes of vomiting were recurrent, they did not subside completely. After 5days they came to our hospital with same complaints and got treated on OP basis. Even after treatment the symptoms did not subside completely. He came to hospital again with same complaints after 1day.

Past history: 25 years back patient had an episode of hemiparesis, and got treated completely for the condition.

15 years back he went to hospital with complaints of dizziness and dry skin, then he was diagnosed with diabetes and hypertension. Since then he was on continuous medication for diabetes and hypertension.

4.5 years back his medication routine was disturbed because of marriage which he conducted as a head of family.

4 years back he under went amputation of left lower limb up to below knee joint because of uncontrolled spread of infected wound.

Personal history:

Diet:mixed

Appetite: normal

Bowel movements:decreased, bladder: slow dribbling urine

Sleep: adequate

Family history: history of diabetes & hypertension in his father, history of diabetes in his elder son.

General examination: patient was conscious coherent and cooperative, well oriented with time place and person. Moderately built and nourished.

Pallor +

Icterus -

Clubbing -

Cyanosis -

Lymphadenopathy -

Edema : + slight facial edema is seen

Provisional diagnosis: hypoglycaemia secondary to insulin

Management

Investigations:

Treatment: