90M with weakness of left UL and LL and hypoglycemia

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Presenting complaints:

90M presented with the chief complaints of sudden unresponsiveness since 6 pm

History of present illness:

Patient was apparently asymptomatic 10 years ago and then developed giddiness for which he went to local hospital and was diagnosed as having diabetes and hypertension (on medication) since then.  H/o weakness of left upper and lower limb  3 years ago, diagnosed as cva . 15 days ago he developed cough with expectoration, white in colour and bilateral lower limb swelling, insidious onset, gradually progressive till knees and fever  low grade, on and off since 15 days and developed sob even at rest for which he went to local hospital and got treated with antiobiotics for 6 days and got discharged on lama and patient symptomatically improved and developed sudden unresponsiveness since 6 pm

Treatment history

H/o medication intake 

K/c/o DM type 2 and HTN since 10 years

T. Glimi m2 since 10 years 

T. Met xl 25 mg po/od

General examination 

No signs of pallor, icterus, cyanosis, clubbing, lymphadenopathy 

Signs of oedema of both feet

Vitals

Temp: 98.6

Pr: 74bpm

Rr: 18cpm

Bp: 120/70

Grbs: 33

Systemic examination

Cvs: s1 s2 +, no murmurs

Cns: 

Stupurous at admission

Power    R        L

  UL      5/5      -

  LL      5/5      -

Glasgow scale: E2V1M5 at presentation

Investigations:

Diagnosis

Oha induced hypoglycemia 

With congestive cardiac failure secondary to CAD

With old cva (3 years ago) left LL and UL

With T2DM (since 10 years) 

With HTH (since 10 years)

With hypokalemia

Treatment:

Inj 25% dextrose @30ml/hr

Stop oha/ insulin

Inj lasix 40g iv/bd

T.ecosprin av 75 10mg/po/ hs

T. Met xl 25 mg po/od

Syrup potklor 15ml in glass of water/ tid

T. Aldactone 25mg po/od