Hemoptysis And DM.

Mr X .aged 70 years c/o acute bouts of blood in the cough .He came with 20 ml of blood collected in the beaker while he was coughing. No h/o of previous episodes of cough,fever,or malaise ,or hemoptysis. Urgent Chest x ray normal. Clinically, Pulse 90/ my normal temp ,BP.180/100 1 hour later 140/80 Blood sugar capillary blood ,554 mg Known DM on insulin. He was taking Glargine 18 units od. Protamine insulin 15 units Bid,advised by his family physician . He was not on any other medication. I have modified his insulin regime Glargine 30 units once at bed time and advised him, short acting plain regular insulin of monocomponant, 15 units,,10 units, 10 units for all meals . Codine phosphate ,HS, Hetrazan 100 mg tids Cetizine 1/He Pantaprazole HS Alprazolm 0.5 mg HS I have advised him to go for CT scan chest .. CBC . HbA1c To come for review. Please comments are welcome. Regarding his Insulin what he was taking. Need your comment regarding the insulin what I have modified his insulin regime. Discuss the cause for the hemoptysis in a normal skiagram situation. High blood sugar will contribute for bleeding diathesis . BP could it be white collar hypertension. Systolic hypertension will it contribute for bleeding into the lumens. Your opinions are most welcome.

I guess here the main problem for which the pt came to you was not deranged blood sugar but hemoptysis or hemetemesis.... Although the sugar is high, it is irrelevant to talk abt it at this time when the pt is actively bleeding though you shd have checked for urine ketones to r/o DKA.... Now you hv not mentioned the colour of the blood which was there in the beaker.... if it's hemetemesis then altered blood will be seen and fresh blood goes more in favour of hemoptysis but things may vary Start with admitting the pt, initial resuscitation alongwith like trenexamic acid and cbc with hematocrit along with BGCM shd be done.... Normal xray does not rule out anything... After the pt stabilizes, do imaging of chest like CECT and also go for UGI endoscopy if you have a doubt regarding the source of blood. While the pt is admitted, control his dugar on regular insulin with sliding scale
This is frank hemoptysis, clear blood in beaker.No blood vomitus.
In a aged diabetic patient with hemoptysis, two most important differentials are infection & malignancy. You didn't mention about his addiction. CECT chest was a perfect test advised by you. Around 20-40% chest x-rays are normal with hemoptysis, so can't rely on chest xray alone.
He is not addicted to any thing

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