70 YEAR OLD MALE WITH UNRESPONSIVENESS UNDER EVALUATION.? HYPOXIC ENCEPHALOPATHY

1st March 2022 

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A 70 year old male was brought to casualty with the complaints of unresponsiveness since today morning associated with excessive snoring and shallow breathing.

HISTORY OF PRESENTING ILLNESS: 

Patient was apparently asymptomatic till the previous day then he was found to be unresponsive when attendants tried waking him up this morning. 

No history of fever, seizures,trauma, vomiting , loose stools , giddiness, chest pain , cough.

History of shortness of breath since 2 days.

History of similar incident in the past (20 days ago) where patient turned unresponsive, for which he was taken to a local hospital and diagnosed with pneumonia and high sugars. Patient was admitted for 8 days and discharged after which he was able to talk, walk (with support) and  do his routines. 

History of similar incident 1 year ago , patient had LOC+ , no S.O.B  for which he was taken to Nalgonda hospital , sugars were found to be > 500 mg/dl. 

Patient is known case of DIABETES MELLITUS since 30 years on INSULIN human mixtard 25units in the morning and 30units in the night ( 25—X—30)

Patient is HYPERTENSIVE since 30 years on ?unknown medication.

History of surgery for    RENAL CALCULI  (30 years ago) 

                                         ↙️                     ↘️  

                                 Kidney 1                    Kidney 2 

                                    ⬇️                                ⬇️    

                             Nephrectomy           Was also operated

                                                              For renal calculi  

                                                              + some problem 

History of APPENDICECTOMY, ; 30 years ago 

In 2015, history of fall from height , patient climbed a wall in order to cut the branches of a tree, and fell from a height of 6 ft. LOC+ , bleeding 🩸 from 👃 and mouth 

In 2019 ,   Intermittently , patient used to wake up at 1 am in the night thinking it’s morning and used to go for walk , also forgetting the way back home  ! 

ECG: