general medicine

HISTORY OF PRESENT ILLNESS:
A 50 year old male patient came to casualty with the complaint of tingling in both the legs as well as arms since one day, and even had the complaint of slurring of speech since 3 hrs.
patient is diabetic since past 10 years and has been incidentally diagnosed.
patient was asymptotic one day back but today morning he developed numbness and tingling in arms and legs for few hours which subsided. But started again at 3:00pm and also complains of slurring of speech.
No H/O vomitings, headache, blurring of vision
No H/O seizures, loss of consciousness.

SURGICAL HISTORY:

4years back due to trauma and uncontrolled Diabetes mellitus, patient 1st thumb and little finger were removed, later all other fingers were removed. since the surgery he is on Daily mixtard 25U once a day.

PAST HISTORY:
 DM since 10 years
 HTN since 6 years and on Tab Amlong 2.5
vitals:
temp: 98.4 F
PR: 93 BPM
RR: 18 com
BP: 130/90 mmHg
Spo2: 98% at RA
CVS: S1 S2 +, no murmurs
CNS: patient is conscious with slurred speech
cerebral signs- 1. finger nose coordination: normal
                          2. knee heel coordination: normal
 provisional diagnosis: 
TIA with uncontrolled sugars
 
CLINICAL IMAGES: 


Investigations:

ECG:
Cxr: 

TREATMENT: 
1- NBM till further orders
2- Allow only water
3- Inj HAI S/C 6U IV/ stat.>> Inj HAI IV infusion acc to algorithm
4- Inj Pan 40 mg IV / BD
5- Inj ondansetron 4 mg IV/ BD
6- IVF NS, RL@ 125ml/hr
7- Inj thiamine 1 Amp in 100 ml NS IV/BD
8- GRBS charting

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