40 yr female with burning sensation of palms

This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.


This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.


I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.

Case 
A 40 yr old female pt with 
chief complaints of burning sensation in palms since 2 months  insidious in onset , gradually progressive   increased intensity at  night is seen 
Not associated with tingling sensation , numbness,paresthesias .
No c/o polyphagia,polydypsia,polyuria,nocturia


K/c/o diabetes mellitus since 3 yrs 
On medication glimi M1 po od 

Past history
She has no similar complaints in past.

Is not a known case of htn,tb,asthma,seizures, thyroid disorders.

Pt got diagnosed as diabetic when visited a hospital for regular checkup 3 yrs ago

She is  uneducated and working as a laundry iron woman since childhood (from 15 yrs) she got married in teenage (at 15 yrs) .Has her first  child  ( at 16yrs) and second child at 18 yrs . Both the babies delivered through LSCS due to baby wt (4 kg) . 

Diet : mixed
Appetite : normal
Bowel and bladder : regular
Sleep : inadequate due to complaints 
Addiction: none

General examination
Patient is conscious , coherent, co operative
No
Icterus
Cyanosis
Clubbing 
Lymphadenopathy
Oedema

Pallor : present 


Temp:98.5°F 
Bp: 140/80 mmhg 
PR:84 bpm
RR: 18cpm

Systemic examination
Cvs : 

Precordium normal 
No thrills ,
On auscultation 
S1,S2 heard ,no murmurs 

CNS: 
Higher mental functions :intact
Cranial nerves :intact
Motor system:Normal power,tone,Gait
Reflexes:normal
Sensory examination:Normal
No meningeal signs
Tremors : absent

Rs: 
Shape of chest:Bilaterally symmetrical, Elliptical in shape
No visible chest deformities
No kyphoscoliosis,
Abdomino thoracic respiration, No irregular respiration

Trachea is central 
Auscultation: 
Normal vesicular breath sounds heard 

P/A
INSPECTION:

Shape of abdomen:Distended

Umbilicus:inverted

Skin over the abdomen is normal with striae.

All quadrants are moving equally with respiration

No visible peristalsis, Hernial orifices intact

External genitalia normal

PALPATION:

Temperature:Not raised
Tenderness:Absent
No Rebound tenderness 
No guarding rigidity
 No  organomegaly 

Percussion
No shifting dullness , 
No fluid thrill

Auscultation
Bowel sounds are heard.

Investigations 
On 3/7/23
FBS : 246 MG/DL
PLBS: 410 MG/ DL
HbA1C: 7.4%

Serum creatinine :0.6 mg/DL

ECG:

On 4/7/23
Blood  urea : 24 mg/dl
Serum creatinine : 0.7 mg/dl


Stool for occult blood : negative 

Reticulocyte count : 1% 

Serum ferritin : 3.1 ng/ml
Normal 11- 306.8 

Serum iron : 42 ug/dl

Chest x ray PA view
On 4/7
5 pm: 254
7pm.: 248
10 pm :312   inj . hai 4 nph 6 
On 5/7
2am:  243
8 am: 245 inj  hai nph 6 units each
10 am : 98
1pm 305 10units hai 
On 4/7
5 pm 254
7pm. 248
10 pm 312 hai 4 nph 6 
On 5/7
2am  243
8 am 245 hai nph 6 units each
10 am 98
1pm :305 10units hai inj 
4 pm :331
7 pm ;211 inj 6 units each hai,nph 
10 pm : 201
On 6/7
2 am :172
8 am :253
4 pm: 331
7 pm: 211 6 units each hai,nph inj 
10 pm: 201
On 6/7
2 am :172
8 am: 253


Diagnosis
Uncontrolled sugars
K/c/o DM 2 since 3 yrs 
Iron deficiency anemia secondary to nutritional /blood  loss

Treatment
Inj HAI  s/c tid  acc to grbs 
8 am ,2 pm,8 pm 
Inj nph sc/bd 
Inj iron sucrose  200 mg in 100 ml  ns /iv /bd 
Tab orofer xt po/od 
Tab limcee po/od 

Patient got discharged on 7/7 

Advised 
Inj hai 10 units sc/tid
Inj nph sc /bd 8 units 
8 am,8 pm 
Tab .orofer. Xt po/od  for 1 month 
Tab . Limcee po/od  for 1 week 









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