45 year F with diabetic neuropathy

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 45 F

at 16 years female child nvd

at 20 years female childnvd

at 23 years female child nvd


husband died 28 years ago ,cirrhosis of liver.

10 years ago  diagnosed as diabetic( 240mg/dl )checked due to  increased frequency  of urine on metformin.

2 years ago , typhoid fever 3 days fever high grade fever with chills and rigors , weight loss started

then she noticed prominence of veins on right leg then on left leg upto knee, itching sensation present from buttocks to feet .

she used to sell fruilts at this time

After 5 months bilateral dragging type of pain in lowerlimbs aggravated on walking for 200 meters and relieved on standing for few minutes.  she quit selling fruits due to this pain and started working in hostel ,after 4 months patient started having burning sensation of both lowerlimbs proximal to distal from knee to feet . then after 3months then she complains bilateral upper limb pains burning sensation from shoulder to fingers , this burning sensation aggravated on full bladder and relieved after micturition.


FAMILY HISTORY: NOsignificant family history


GENERAL: patient is c/c/c well oriented to time , place and person

No Pallor,icterus,cyanosis,clubbing ,lymphadenopathy and edema






VITALS:

Temp: 98Af

Bp-110/70 mmhg

PR- 72bpm

RR- 18cpm

SYSTEMIC EXAMINATION 

CNS : 

HMF :INTACT

CNS EXAMINATIIN: Decreased vibration duration 4 seconds at medial malleolus

length dependent ,

JOINT EXAMINATION: Jobes test positive

CVS EXAMINATION: S1,S2 hears no murmurs

RS: Bae+, NVBS

PER ABDKMEN SOFT NON TENDER 

INVESTIGATIONS 





TREATMENT:

1)INJ HUMAN ACTRAPID INSULIN 6 UNITS TID

2) INJ NPH 8 UNITS BD

3) TAB.PREGABS 75 MG PO/HS

4) LIMB ELEVATION AND COMPRESSION STOCKINGS 


45 year old female


 

S decreased pain,burning sensation

 complaining of left upperlimb pain


O

Patient is c/c/c

Temp:- 98 F

PR- 88 bpm

BP-  110/60mmHg

GRBS- 272mg/dl


CVS- S1s2present, no murmurs heard

RS-B/L air entry present 

       NVBS present

PA- soft,NT

CNS - NFND



A

DIABETIC NEUROPATHY  WITH BILATERAL VARICOSE VEINS




P:

1)INJ .HUMAN ACTRAPID INSULIN S/C TID before meals

2) TAB.PREGABA- M 75 MG PO/HS

3) GRBS 7. PROFILE

4) LIMB ELEVATION AND COMPRESSION STOCKINGS


DISCHARGE SUMMARY

PATient admitted in ward and examined cns clinically  

Maintained stable sugars for 2 days .

discharged on 3rd day  with HAI and NPH 


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