DR DHIYA FARIZA BINTI NORIZAN

PEGAWAI PERUBATAN KLINIK KESIHATAN MACHAP BARU

 Pn SA, 29 year old, Malay lady
 Underlying hypertension
 Came to clinic complaining of headache, neck pain, lethargy.
 Had on and off episodes of frequent urination especially at night.
 Itchiness over private part prior to urination started 3 months postpartum.

 Otherwise no nausea, no vomiting. No history of fall or trauma.

 Claimed compliant to medications.
 Denied the urge to drink plenty of water (polydipsia). Claimed usually drinks more than
3litres of water per day (combination of plain and sweat drinks).
 Denied polyphagia. Claimed has always had ‘big appetite’.
 No recent weight loss.

 What is your next step?

 Any differential diagnosis?
 Further history
 Mother and Father both have Diabetes Mellitus Type 2 on medications
 Claimed of being obese since young age with BMI >25

 Patient’s medication
 T. Amlodipine 10mg daily.
 On examination: Alert, Pink, Good hydration, Not tachycardic, Good pulse volume.
 Weight : 100.7 kg
 Height : 158cm
 BMI 40.3
 BP: 139/96, PR: 91bpm
 Lungs: clear CVS : drnm
 PA: soft non tender
 Per vaginal examination : NAD
 Investigation order
 UFEME
 Glu 1+

 GM STAT
 11.2mmol (capillary)
 Random blood sugar (RBS)
 12.8mmol (venous)

 Renal Profile, FSL and HbA1C.

 Urea 3.19

Potassium 3.36

Renal Profile
Sodium 129

Creatinine 56

TC 3.6

TG 0.61

FSL Glu 11.2

HbA1C
ALT 22

HbA1C 7.9%
 Diagnosis : Newly Diagnosed Type 2 Diabetes Mellitus.

 Management
 Refer dietician.
 Refer for fundoscopy.
 EOD GM monitoring.
 Started on T. Metformin 1g BD.
 TCA 2weeks to review blood investigations.