ENDOCRINOLOGY #12

Chief complaint: Elevated blood sugars uncontrolled by high dose out patient in some
history and physical findings, the patient is an 80-year-old white male with history of
Type II Diabetes and mentally requiring insulin with recent flare of his chronic
congestive heart failure and bronchitis which resulted to elevated blood sugars. He has
been in glucontrol 15 mg b.i.d. But blood sugars were going over 400 on his glucometer
home for the last week and a half. He was started on insulin and it still increased to 90
units/day given concomittantly with glucontrol. He was also given seroxalin for the flare
up of congestive heart failure he had last week. As a result, his blood sugars had not
come down significantly still running faithfully off the scale on the glucometer at home
running as high as 557 two days ago at laboratory. His sodium is drop from the mid to
high 120s is down to low 120s and the BUN creatinine is the reason secondary to
seroxalin as in the past period. Hes been treated with Apison for his Bronchitis. The
patient also has a history of pre melanonephrostomy tube ureteropelvic junction
dysfunction. Medications: allopurinol 100 mg b.i.d., Lasix 160 mg a.m., 120 mg p.m.
Felvin 20 mg q.a.m. Metamucil 2 tbsp. hs. Carbocisteine 101 every 46 hours p.r.n. pain
Nubain 15 mg hs. Nitroglycerin 0.4 mg sublingually p.r.n. chest pain Nicropreitin one to
three times per day Cardizem 60 mg q.i.d. Isordil 30 mg q.i.d. He had 95 units of insulin
a day prior to admission and I believe 80 units of combined NPH and Regular insulin the
day of admission.
Physical exam
Vital Signs: Temperature=97.7, pulse=72, respirations=28, BP=120/70.
Neck: general obese, white male. HNT: pro normal. Fundi: TMs normal. Pharynx
clear. Neck of the back: JVD corner regular rate rhythm. Lungs clear. course no rales.
Abdomen: obese without masses. Back: With left nephrostomy tube. Genital:
uncircumcised male. Testicular edema that was noted last week in the office prior to his
Roxaline therapy is now resolved. Extremities: 1+ edema extending all the way to the
thighs and presacral area. He is wearing tips hose. Right leg was worse than the last as
per usual. Lab CBC, white blood count is 7,000 it was 66 polies is 22 3 lamps 8 minus 3
eos .hematocrit is 45 io blood sugar upon admission 445,electrolyte sodium 115,
potassium 3.2, chloride 72, CO2 32, BUN 73, and creatinine 2.6.
CONSULTATION:
IDENTIFICATION HISTORY:
IMPRESSION:
1. Type 2 Diabetes- flare ups secondary to congestive heart failure and bronchitis.
2. Recent exacerbation of congestive heart failure-resolved.
3. Hyponatremia probably secondary to hyperglycemia (artificial close) seroxylin.
Acute exacerbation of chronic renal failure secondary to seroxylin.
4. Recent history of decrease sodium -probably secondary to Lasix and seroxylin of the
Lasix dose has been chronically the same.

RECOMMENDATIONS: The patient would be given subcutaneous and IM in as

required to bring his blood sugars down to more acceptable range and then NPH and
regular insulin would be given split dose b.i.d. dose in measurement.