糖尿病的急性并发症.pptVIP

Morbidity report R5 王舒儀 93-1-29 Name : 曾X Age : 81 y/o Gender : male Admission date : 92-08-07 Married , Minnan Taiwaner Occupation : unknown BW : 59kgw BH: 165 cm ? BMI: 21.6 Smoking (-) Chief complaint Sudden onset of general weakness this morning about 10:00 Am Present illness This patient is a case of (1) COPD with regular medicine control (2) hypertension for several years and discontinued medicine therapy for 2-3 months recently. (3) type 2 DM noted for 3 years without control for several months . He was well before this admission . In recent 3 days , he began to have slurred speech . Acute onset of general weakness , right eye-lid ptosis and motor weakness noted by family on 8/7 . He was sent to our ER and hyperglycemia was noted . Then he was admitted under the impression of NKHS. Physical examination Consciousness : E4V5M6 BP : 164/84 mmHg ? 220/90 mmHg , HR : 70 RR : 20/min , Body temperature : 36.4 Neck :supple, no LAP, thyroid – impalpable Heart sound : Regular heart beat Breath sound : clear Abdomen : soft , no tenderness ,hyperactive bowel sound , distension L/L : no edema , no cyanosis Dry skin turgor Neurological examination Consciousness : clear, alert, orientation :fair Verbal output : fair with dysarthria Eye: light reflex +/+, 2.5/2.5 EOM: right eye mild limitation , -1~-2 deviation to left side Diplopia (-) , choking (+), Uvula deviated to right side Muscle power : RUL: 4+, RLL:4+, LUL:4-, LLL:4- Barbinski sign :negative Urine incontinence (+) Sensory : impairment of lower legs , bilateral Lab data -1 Blood gas --- pH : 7.436 , PO2: 86, PCO2: 36.2, HCO3: 24.6 Glucose ( spot ) : 732 Cr : 1.8 Na: 128 , K : 4.8 Effective osmolality – 306.2 Lab data -2 Hemogram --- WBC:13100 /ul ,Hgb : 14.6 g/dl , platelet : 232000/uL Urinalysis --- glucose : 1.0 , ketone - ,protein : - ,WBC esterase - , WBC 0-1 HbA1c : 11.5 % Cholesterol : 237 , HDL : 48 , TG