HYPOGLICEMIA EC TYPE II DM

By : Sekar Kinasih Susilo Putri , MD

Supervisor : M. Diana Rahim, MD

Indonesian Doctor Internship Program

Guntur Hospital Garut
September 2021
PATIENT IDENTITY
Name : Ny R
Age : 50 years old
Gender : Female
Med Record Number : 170056
Admission Date : September 23 2021
Time : 09.40 AM
GP : dr. Pratama
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HISTORY TAKING
Chief complaint : weakness
The patient came to the ER from the internal medicine clinic
with complaints of weakness. Previously, the patient was
known to be fasting since 23.00 and wanted to check FPG. The
patient admitted that 2 months ago she often felt weak, hungry
easily, frequently urinated and often had tingling sensations.
Then she checked herself and got the results of the RPG
examination of around 500 mg/dl.

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The patient admitted that she used insulin regularly for 1 month
with 3x15 U every day. The patient also complained of nausea
and dizziness. There are no defecation and urination complaints.

According to her family, the last few days the patient only ate
little food because fear of rising blood sugar. The patient has
history of hypertension, heart problem, and stomach problem.
Over the past 3 weeks, patient take Nitrokaf 1x5mg,
Clopidogrel 1x75mg, omeprazole 2x1 tab, Simvastatin 1x15mg,
Amlodipine 1x10mg, Braxidin 3x1 tab and insulin.

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PHYSICAL
EXAMINATION
General Condition : looks weak
Awareness : CM
GCS : 14
Blood Pressure : 140/80 mmHg
Pulse Rate : 93x/minute
Respiratory Rate : 20x/minute
Temperature : 36,7 C
Oxygen Saturation : 96% free air

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Head
Eyes : anemic conjungtiva -/-, icteric sclera - / -
Nose : nostring breathing ( - )
Mouth : cyanosis ( - )
Neck : lymph node enlargment ( - )

Thorax : symmetrical chest movements

Cor : S1 S2 regular, gallop (-), murmur (-)
Pulmo : vesicular breath sounds, crackle - /-, wheezing - / -

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 Abdomen : flat, soepel, bowel sound (+) normal,
tenderness in epigastric region
Liver : within normal limits
Spleen : within normal limits

Extremities :
Cold, CRT > 2 second, Edema ( - ),

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SUPPORTING
EXAMINATION
LABORATORY EXAMINATION RESULT (23-09-
2021)
– Blood Routine:

• Hemoglobin : 11.5 gr %

• Leucocyte : 7200 /mm2

• Hematocrite : 36.5 %
• Thrombocyte : 346.000/mm3

– Immunology :

• Rapid antigen Covid-19 : Negative

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LABORATORY EXAMINATION RESULT (23-09-
2021)

Blood Chemistry :

• Fasting plasma glucose : 28 mg / dl

• Ureum : 33 mg/dl

• Creatinin : 1.68 mg/dl

• SGOT : 13 U/L

• SGPT : 12 U/L

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LABORATORY EXAMINATION RESULT (23-09-
2021)

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RONTGEN THORAX (23-09-2021)

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ECG (23-09-2021)

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DIAGNOSE
● Hypoglycemia with type 2 DM
● Acute Gastritis

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MANAGEMENT
● IVFD D10% 30dpm
● D40% 3 flash iv bolus evaluate plasma glucose 30 minute later
● Inj Omeprazole 1x40mg
● Histigo 2x1 PO

10.30 am
● Blood sugar ( after D40% 3 flash bolus )  226
● Stop D10% 30 dpm Asering 20 dpm

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Advice Dr Ferry Sp.Pd
● Inj novorapid 3x10 unit, eat meal more than ½
portion
● Evaluate RPG/8hours
● Stop Histigo
Blood glucose
13.00 340
21.30 223

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FOLLOW UP
Friday, September 24 2021 (dr Fasyal)
SUBJECTIVE OBJECTIVE
Weakness + BP :134/78, P : 80,
RR 20, T : 36.8 C
Dizziness + SpO2 97%
FPG 06.00 251
Abdominal pain + RPG 14.00-
RPG 20.00 -

• IVFD NS 20 dpm
• Hypoglycemia • Inj Omeprazole 1x40mg
• Type 2 DM • Inj Novorapid 3x10 U
• Acute Gastritis • RPG/8hours
ASSESSMENT PLANNING
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Saturday, September 25 2021 (dr Emil)
SUBJECTIVE OBJECTIVE
Weakness + BP :123/75, P : 78,
RR 20, T : 36.8 C
Dizziness + SpO2 97%
FPG 06.00 : 161
Reduced bdominal pain RPG 14.00 : 373
RPG 20.00 : 240

• IVFD NS 20 dpm
• Hypoglycemia • Inj Omeprazole 1x40mg
• Type 2 DM • Inj Novorapid 3x10 U
• Acute Gastritis • RPG/8hours
ASSESSMENT PLANNING
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Sunday, September 26 2021 (dr Hilmi)
SUBJECTIVE OBJECTIVE
Weakness + BP :130/80, P : 92,
RR 20, T : 36.8 C
Dizziness - SpO2 97%
FPG 06.00 : 171
Abdominal pain - RPG 14.00 : 240
RPG 20.00 : -

• IVFD NS 20 dpm
• Hypoglycemia • Inj Omeprazole 1x40mg
• Type 2 DM • Inj Novorapid 3x10 U
• Acute Gastritis • RPG/8hours
ASSESSMENT PLANNING
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Monday, September 27 2021 (dr Heriyandi)
SUBJECTIVE OBJECTIVE
Weakness - BP :130/80, P : 79,
RR 20, T : 36.8 C
Dizziness - SpO2 97%
FPG 06.00 : 152
Abdominal pain -

• IVFD NS 20 dpm
• Hypoglycemia • Inj Omeprazole 1x40mg
• Type 2 DM • Inj Novorapid 3x10 U
• Acute Gastritis • RPG/8hours
ASSESSMENT PLANNING
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Advice dr. Ferry, Sp.PD
● Patient can go home
● Insulin 3x10 U
● Omeprazole 2x1 tab

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 “
Thank you for the attention..
Any question?

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