67 year old male with recurrent hypoglycemia

A 67 year old male was brought to the casualty with:

 C/O 2 episodes of double vision and slurred speech and cool peripheries since yesterday. For which he was taken to an outside hospital and was found to have GRBS 35 and was given 25% Dextrose. 

C/O burning micturition and increased frequency of micturition since 1 month. 

K/C/O Carcinoma rectum since 1.5 years - underwent CT + RT

Patient is on liquid diet since 6 months but ate non veg 2 days ago after which he c/o abdominal bloating since 2 days. 

No c/o fever, vomiting, loose stools, pain abdomen. 

Patient c/o decreased appetite since 6 months and is not eating well,so attenders were giving only liquid diet most of the time and he eats food sometimes. 

Past history:

K/C/O DM since 10 years on T. METFORMIN 500mg 1/2 tab OD.

K/C/O HTN since 11 years on T. AMLONG 5mg OD. 

K/C/O CA rectum.

Personal history:

Diet-mixed

Appetite-normal

Sleep-adequate 

Bowel and bladder movements-regular

Daily Alcohol consumer since 30 years,stopped 2 years back.

Family history:

Not significant 

General examination:

Patient is conscious, coherent, cooperative. 

Vitals on admission:

Temp: 98.2°F 

PR: 72 bpm 

BP: 130/90 mmhg 

RR: 18/min 

SPo2: 98 % @ RA 

CVS - S1 S2 + 

RS - BAE + 

P/A - distended,shifting dullness+

CNS - No FND

Investigations:

Provisional diagnosis: 

Recurrent hypoglycemia under evaluation secondary to sepsis? ALI (? Liver mets)

 K/C/O CA rectum (CT + RT completed) with B/L HUN, with DM type 2, HTN

Treatment:

1) INJ. PANTOP 40MG IV OD

2) GRBS CHARTING HOURLY MONITORING

3) IVF 25% DEXTROSE @ 10ml/hr

4) T. AMLONG 5MG PO OD

5) STOP OHAs

6) BP/PR monitoring