THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT.

A 50 year old female presented with CC of Nausea and Vomitings since 3 days, heavy menstrual bleeding since 18 months.

✓HOPI-

Patient was apparently asymptomatic 18 months back then she started having heavy menstrual bleeding(7/20; 4 pads per day) associated with clots. Not associated with allpain.She went to a local RMP and got an injection for it. The symptoms subsided for a month. Then she had the same complaints in the next month.

H/o weight loss since 1year. She lost around 15kgs (present weight- 32kgs; 1 year back she was 48kgs). There is no history of chronic cough, loss of appetite.

H/o Vomitings since 3 days, bilious in nature, preceded by nausea, food as content, aggravated on taking food and water, 10-15 episodes per day and not relieved on medication.

No H/o Fever, pain abdomen, loose stools, or intake of spicy food.

✓Past History -

K/c/o DM. She's on Medication (Glimiperide). And on Insulin since 15 days.

Not a kco HTN, TB, Asthma, Epilepsy, CAD.

✓Personal History-

Appetite - Normal

Diet- Vegetarians ( Eats egg also)

Sleep- Adequate

B&B- Regular

Addictions - Nil

✓ Menstrual History -

LMP:- 13/7/22 

Age of menarche:-13 yrs

Past cycles:-

4/30 regular cycles

Not associated with pain and clots 

2 pads per day.

Present cycles:- 

Heavy mentrual bleeding since 18 months 

Associated with clots but not associated with pain. 4 pads per day.

✓Obstetric History -

Tubectomised

P3 L2 D1

✓Family History - Not Significant

General Examination -

GENERAL EXAMINATION:-

Patient is conscious coherent and cooperative and well oriented to time, place and person.Weakly built and malnourished. 

Vitals:

Temperature - 98.4 F

PR :- 80 bpm

RR :-18 cpm

BP :- 120/60 mm Hg

SPO2 :- 95%

GRBS :- 189 mg / dl

Pallor- Present

No icterus, cyanosis, clubbing, No Generalised lymphadenopathyo, No b/l pedal edema.

Systemic Examination:

CVS-S1, S2 heard,no murmurs

Respiratory System:-

 BAE- present 

NVBS- heard

PER ABDOMEN:-

 soft , non tender.

CNS- NAD

Clinical Images -







Investigations -

ECG-


X ray chest


6/8/22










7/8/21





Provisional Diagnosis -

DKA 2° to inadequate insulin 

Adenomyosis

Anaemia under Evaluation 

Type 2 DM since 13 years.

Treatment -







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