Gen Med

 32 M , autodriver pt presented to casuality with SOB grade 2-3 since 2 days , vomitings since 2 days Pt was apparently asymptotic 6 years back  Pt c/o polyuria , polyphagia and went to KIMS for evaluation and diagnosed with DM type 1 and started on insulin mixed 25U—-X—25U and shifted to insulin 20U—-X——20U since 4 years  HOPI - since 2 days pt c/o vomiting 3-4 episodes / day , associated with food particles not associated with bile , blood , associated with abdominal pain , squeezing type   Relived after vomiting ,associated with SOB grade 2-3 , no organomegaly , no PND  No c/o loose stools , constipation, burning micturation  No c/o chest pain , palpitations , syncopal attacks  No c/o abdominal distension , pedal edema  H/o Dm 1, since 7 years  No H/o HTN, CUA, CAD , TB , Asthama , epilepsy  No H/o abdominal pain  No similar complaints initially at the time of presentation  O/E : pt is c/c/c  Temp: 99.8 F  Pulse : 102 bpm Bp- 140/80mmhg  Spo2: 98% GRBS: 480mg% Ketones : POSITIVE    

 52 /M , saree weaver by occupation presented with h/o slurring of speech ,deviation of mouth -that lasted for 1 day and resolved on same day . Brain imagining was done which showed cerebellar infarct and denovo HTN + patient was asked to continue medication regularly but he didn’t  He is chronic smoker 1 pack of beedi/day and chronic alcoholic since 30 years consumes 90 -180 of Ib thrice weekly  Pt gives h/o - giddiness -5 days back at 7 am in the morning pt was on routine works and suddenly at 7am .pt felt giddiness and took rest .it was associated with 1 episode of vomiting  on the same day pt had h/o  postural instability , while walking to and was about fall no seizure like activity Pt was assyptomatic for 3 days then he consumed small amount of alcohol  Pt was assymptomatic till 3pm then the patient developed -giddiness , sudden onset and gradually progressive , continuous and increased on getting up from bed , while walking , associated with B/L hearing loss , aural fullness , t