Medicine case discussion

38 year old female came to casualty with complaints of giddiness since 2 days and headache since 2 days. 

HISTORY OF PRESENT ILLNESS
Patient was apparently asymptomatic 1 year back, then she developed giddiness which is on and off and not associated with palpitations, shortness of breath, blackouts, chestpain, sweating, blurring of vision, decreased urine output. 6 months back, she had sudden onset of giddiness followed by fall  with fracture of nasal bone. ENT opinion was taken and on conservative management. She complaints of headache since 6 months which is on and off and holocranial not associated with nausea and vomitings. 
She had history of trauma 2 years back for that she went for checkup and diagnosed as DM type 2.
Patient had history of pedal edema 1 year back and said to have? Renal problem. 
No history of tingling and numbness of foot. 

HISTORY OF PAST ILLNESS
Known case of diabetes since 2 years
No h/o HTN, Bronchial asthma, Tuberculosis.
TREATMENT HISTORY
On medication for diabetes since 2 years(Glycomet gp1)
 
PERSONAL HISTORY
Married
Occupation : Housewife
Appetite: Normal
Diet : Mixed
Bowel and bladder:Regular
No known allergies
No addictions

FAMILY HISTORY
Not significant

PHYSICAL EXAMINATION
No pallor, icterus, cyanosis, clubbing, lymphadenopathy, oedema 

TEMPERATURE:Afebrile
PR:98bpm
RR:18 CPM
BP:120/80 mmhg
Spo2 97%
GRBS 178mg/dl

SYSTEMIC EXAMINATION

CVS :No thrills, no murmurs, s1 and s2 heard

RESPIRATORY SYSTEM
Trachea central
No Dyspnoea
No wheeze

 ABDOMEN:NAD

CNS: NAD

PROVISIONAL DIAGNOSIS:Giddiness under evaluation

INVESTIGATIONS:Haemogram
CUE
Blood Urea
ECG

CXR PA view

RBS

HBA1C

USG
Serum Electrolytes
TREATMENT:
Day 1(22/06/2021) 

Vitals
Temperature :Afebrile
Pulse rate: 92 bpm
Blood pressure:120/90 mmhg
GRBS:178 mg/dl

1.IV fluids
2.Tab ULTRACET
3.Tab PANTOP
4.Tab GLIMI M1
5.GRBS 6TH hourly
6.Bp/Pr/Temp 4th hourly
7.I/O charting

Day 2(23/06/2021) 

Vitals
Temperature:Afebrile
Pulse rate:98 bpm
Blood pressure:120/80 mmhg
GRBS:  164   mg/dl

1.plenty of oral fluids
2.Tab ULTRACET
3.Tab PANTOP
4.Tab GLIMI M1
5.GRBS 6TH hourly
6.Bp/Pr/Temp 4th hourly
7.I/O charting
Discharge Summary
 
COURSE IN HOSPITAL
 
Patient came with complaints of giddiness and headache since 2 days on presentation vitals stable.patient is known case of diabetes and HBA1C 6.8.patient had similar complaints in the past when ever she works in hot sun and standing for long hours.on day 1 symptoms subsided.Empleys maneovoure done which is normal.patient doesnot have giddiness or nystagmus during the procedure .Sugars were monitored during hospital stay.Sugars are under control.Patients does have similar episode and feeling relieved so patient has been relieved and asked for follow up after 1 week.On supine position vitals are normal[PR 88 BPM,BP 130/90 MMHG] on standing position PR 98 BPM AND BP 130/80 MMHG

Treatment
On 22/
 

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