ALCOHOL INDUCED HYPOGLYCEMIA

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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.

A 55 year old male came to medicine opd with CHIEF COMPLIANT OF 

Alcohol binge since 3days

Weakness since 3days

Decrease urine output and yellow in colour since 1day (15-07-22)

HOPI 

Patient was apparently asymptomatic 10yrs back the he started drinking alcohol occasionally during parties and festivals which gradually increase in quantity and frequency  from past 5yrs from past 3days he  has on alchol binge stoped taking food intake ,started feeling lethargic ,had 5 episodes of vomiting which is watery,non bilious,projectile.

He was counsious but unresponsive on that day

H/o slurring of speech.

H/o decrease urine output and dark  yellow in colour 

Craving to alchol is present but no h/o of withdrawal symptoms.

No h/o sweating, palpitations, sleep tremor 

Daily routine

He wakes at 5am and complete his daily routine and goes to farming by 8am and return back at 5pm and complete evening routine and he drinks alcohol daily from the past 5years and have his dinner sleep by 9pm.

Past history

No h/o dm,htn,tb,asthma, epilepsy

Personal history

Diet-mixed 

Appetite -normal 

Sleep -reduced 

Bowel and bladder - uo decreased and yellow in colour.stools  are regular

Addiction -consume Alcohol daily (beer-180ml -250ml)

General examination 

Pallor absent

Icterus absent

Clubbing absent 

Cynosis absent

Lymphadenopathy absent

Edema absent

Vital 

Pulse 106/min 

RR-18/min

Temperature afebrile 

Bp 110/70mm Hg 

Spo2 99%

Abdominal Examination 

Inspection no scar no pulsation 

Palpation non tender, liver is palpable

Auscultation normal bowel sounds 

Rs: bilateral air prst 

Cvs s1 s2 heard ,no murmur

Cns no focal neurogical deficient 

Investigation 

Provisional diagnosis 

Alchol induced hypoglycemia 

Treatment

Inj . thiamine 200 mg iv tid

Heptagon od 

Inj lasix 

Inj zofer 4mg/iv

18/07/22

Platelets count reduce to 36000 

19/07/22

Platelets count increased to 68000

Blood glucose level is normal