68 year female complaint of Rt shoulder pain for 4 days back , vertigo and fall down towards left side and nausea/vomiting for 4 days ..... H/ O chronic Hepatitis B for 3 years T2 DM ,HTN on medicine (CTD 12.5 ,Amlopress AT ,Triobimet 2 ) O/E BP 132/74 Pulse 65 ECG wnl Suggest treatment ???

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Uncontrolled DM lead to ??HONK . MRI whole spine , and manage hyperuricemia.

She merits Insulin therapy, give her Oral CEFURUXIME TYPE DRUGS POSSIBLE UTI, WORK UP SEPSIS PROTOCOL. FULL WORK UP FOR T2DM

HBV WITH HYPERGLYCEMIA PAIN IN RT. SHOULDER RULE OUT OSTEOARTHRITIS / DO VIRAL PCR FOR HBV INFECTION because Raised alkaline Phosphates it develops vomiting & Partial seizures due to raised sugar level, Do - USG W/A, HBV DNA, Anti-HBe , Anti -HBc IgG, anti - HBc IgM, HBeAg, HBV Viral PCR, HbA1C, C - Peptide, Lipid Profile, For Raised UA give tab. Febustop 40 mg, Fibroscan test for liver, treat symptomatically & supportive

Thnx @Dr. Vipin Bihari Jain Sir Ji
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This is a case of chronic hepatitis B with inactive stage. It doesn't require any treatment. Pt may have cervical spondylosis with Vertebro basal insufficiency. Do MRI C- SPINE &treat accordingly. Uncontrolled diabetes with mild proteinuria also there.. (Could be autonomic neuropathy) Start insulin or OHA depends on Hba1c levels.

Uncontrolled DM Changes dosage of sugar drugs or insulin Add Febuxostat 40 hs for hyperuremia Lifestyle changes

Thank you doctor
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Control Dm by adding basal insulin Add Febuxostat control UA Vomiting may be related to high sugar and Uric acid, avoid ketosis

Thank you doctor
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Pain rt shoulder, vomiting a d vertigo recent onset for 4 days may be due to degenerative changes osteoarthritis causing compression of the vertebral artery and rule out frozen shoulder Pt having hepatitis B treat with liver supportive and strict diabetic control MRI cervical spine may lead to proper diagnosis.

Thanks Dr Kvsv.
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In this case hepatitis B not need to be treated because liver profile and viral load are it self shows that its inactive Vertigo and nausea is due to hyperglycemia So treat hyperglycemia accordingly . See for hba1c to rule out neuropathy if its continue high So control hyperglycemia

Thank you doctor
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Hepatitis B do not require any treatment of 1) liver enzymes are normal, which indicate inactive disease 2) Viral load less than 2000iu/ ml which again indicate inactive disease 3) if fibroscan shows no fibrosis - which again indicate inactive disease Secondly she has highly uncontrolled diabetes - it is preferable to start Glargine insulin for us treatment Vertigo may be related to uncontrolled diabetes

Thank you doctor
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