Giddiness under evaluation secondary to a) HTN ? b)Autonomic neuropathy ? with denovo HTN with hyperternsive retinopathy with k/c/o DM-2 with diabetic neuropathy .

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A 35yr old male patient resident of chinakaparthy came to the casualty with 
c/o giddiness since 2days (19/12/21) , non rotational , duration-10min, aggravated on standing , relieved by supine.

HOPI - 
Patient was apparently asymptomatic 2days back and had an episode of giddiness , where he went to the local RMP and was found to have increased BP and patient had given TAB .AMLONG , TAB .ATENOLOL and didn't have any episode of giddiness .
From yesterday morning patient again started c/o giddiness and from yesterday afternoon c/o vomitings - non bilious , 2-3 episodes , non projectile and came to our hospital for further evaluation .
H/o alcohol intake 2days back .

Past History - k/c/o DM since 10yrs .
Not a k/c/o HTN , TB, Asthma , CAD, CVD 

Personal history -
Diet - mixed
Appetite - normal
Bowel & bladder movements - regular 
Addictions - occasional alchol intake 

Family history - not significant

On Examination 
patient is c/c/c
No pallor , icterus , cyanosis , clubbing lymphadenopathy ,  edema

Vitals -
Temp - Afebrile 
PR - 90bpm
BP - 150/90 mmHg
RR -14cpm
GRBS - 98%@RA 
SpO2- 98%

Systemic examination -
CVS - S1 S2 +VE 
RS -BAE +VE , NVBS +VE 
P/A - soft , non tender , BS +ve 
CNS - NAD 

Provisional diagnosis - 
Giddiness under evaluation secondary to 
a) HTN ?    b)Autonomic neuropathy ? with denovo HTN with diabetes 

Investigations

Treatment -
INJ. ZOFER 4MG /IV/TID 
INJ.PAN 40MG /IV/OD
T. AMLONG -5MG/PO/OD 
T.GLUCORYL M2 PO /OD
T.ZINCOVIT PO/OD 


Day1
AMC 
Bed no 2

S-
c/o giddiness + , no c/o vomitings 

O-
patient is c/c/c
Temp - Afebrile 
PR - 90bpm
BP - 150/90 mmHg
RR -14cpm
GRBS -152 mg/dl
SpO2- 98%@RA
CVS - S1 S2 +VE 
RS -BAE +VE , NVBS +VE 
P/A - soft , non tender , BS +ve 
CNS - No nystagmus , sensory decreased (L<R)-fine touch , temperature , vibration .
Rombergs -ve 

A-
Giddiness under evaluation secondary to 
a) HTN ?    b)Autonomic neuropathy ? with denovo HTN with hyperternsive retinopathy with k/c/o DM -2 with diabetic neuropathy 

P-
INJ METOCLOPROMIDE 2CC IV/BD
INJ. ZOFER 4MG /IV/TID 
INJ.PAN 40MG /IV/OD
INJ. HAI ACC TO SLIDING SCALE (8AM -2PM-4PM)
T. PROMETHAZINE 25MG PO/TID
T.VERTIN 16MG PO/TID 
T.DOLO 650MG PO/TID

Day 2
AMC 
Bed no 2

S-c/o giddiness + , no c/o vomitings 
AMC 
Bed no 2

S-c/o giddiness + , no c/o vomitings 

O-
patient is c/c/c
Temp - Afebrile 
PR - 90bpm
BP - Supine -120 mmHg
         Sitting -110mmHg
RR -14cpm
GRBS -152 mg/dl
SpO2- 98%@RA
CVS - S1 S2 +VE 
RS -BAE +VE , NVBS +VE 
P/A - soft , non tender , BS +ve 
CNS - No nystagmus , sensory decreased (L<R)-fine touch , temperature , vibration .
Rombergs -ve 

A-
Giddiness under evaluation secondary to 
a) HTN ?    b)Autonomic neuropathy ? with denovo HTN with hyperternsive retinopathy with k/c/o DM -2 with diabetic neuropathy 

P-
INJ. ZOFER 4MG /IV/TID 
INJ.PAN 40MG /IV/OD
INJ. HAI ACC TO SLIDING SCALE (8AM -2PM-4PM)
T. PROMETHAZINE 25MG PO/TID
T.VERTIN 16MG PO/TID 
T.DOLO 650MG PO/TID

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