Patient was brought to hospital by her sister whom she lives with.

She claimed that since one month ago, patient had been showing hallucinatory behavior in which
she had gesturing acts like she is communicating with someone.

She also had disorganized behavior such as bringing pots and pans into her room, claiming it was
hers and putting a plastic bag over her head.

Patient also had reduced amount of sleep (2 hours/day).

Patient was described as childish by her sister and would laugh inappropriately at times.

Besides that, patient had reduced oral intake for 1 week in which she only took 3 spoons of rice per
day.

For the past 2 days, patient started to be aggressively and excessively irritable towards her elderly
mother and sister at home (threw glass bottles and cups).

Patient had underlying T2DM on s/c Mixtard 24U OD and s/c Insulatard 28U ON.

Since 2 days ago, patient had been defaulting medications. Therefore, her sister brought her to the
ward as she was not confident to administer the injections for her sister at home.

Patient was diagnosed with schizophrenia in 1999. Since then, she has been compliant to
medications until 2 months ago.

Dextrostix 17.8 (Given s/c Actrapid 6U stat)

Urea 7.0
Creatinine 121.3
Na 139
K 4.2
LFT Normal
Fbc: Hb 9.9
TWC 8.4
Platelet 278
HbA1c (19/6/2019) 10%
FBS 14.08
UFEME Protein negative

Investigations Results
FBC Hb 9.9
TWC 8.4
Platelet 278
MCV
MCH
MCHC
Liver function test Normal
Renal profile Urea 7.0
Creatinine 121.3
Na 139
K 4.2
UFEME Protein Negative
T2DM Dextrostix 17.8 (Given s/c Actrapid 6U stat)
FBS 14.08
HbA1c (19/6/2019) 10%


 Management
o General
 Admit to psychiatry ward
 IVD 3 pint NS /24H
 Dextrostix QID daily
 Strict IO chart
 Encourage orally
o DM
 Old medication
 S/C Mixtard 24U ON
 S/C Insulatard 28U OM
 In ward
 S/C Actrapid 12U TDS
 S/C Insulatard 18U ON
 Upon discharge - Off Insulatard >> To convert to OHAs only for compliance
 T. Metformin 850mg TDS
 T. Diamicron MR 90mg OM
 T. Gliclazide MR 90mg OD
 TZD (Pioglitazone) 30 mg OD
o Hypertension
 T. Perindopril 4 mg OD
o Dyslipidemia
 T. Simvastatin 20 mg ON
 T. Fenofibrate Supra 160mg OD
o Antipsychotic
 T. Aripiprazole 20mg OD (increased from 10mg)
 Upon discharge: IM depot Maintena 400mg (Aripiprazole) for compliance
o Sedative-hypnotic (for insomnia)
 T. Stilnox 10mg PRN (Zolpidem)

 Dxt latest: 9.3/8.0/6.2/6.3


 She lives with elder sister and mother
 Premorbid, have been helping sister doing chores, but for past 1 year, didn’t do , only
perform prayers at times, verbally abusive at times
 Since this past 2 months she has not complaint to treatment
 Sister tried to help administering the insulin for her but she refused help from others
 She only want to do it by herself but frequently missed taking the treatment
 Sis just asked pt abt med daily, but did not see pt taking it
 Discussed with sister and patient about converting the insulin to OHAs, patient agreed her
oral meds to be kept by sister and on the time of taking meds, sister will give her the tablets

 HBA1c – 10%
 FBS 14.08
 UFEME – protein negative
 Creatinine 99 (baseline eGFR :55)

 AKI –resolvied
o Urea 7.0 >> 4.3
o Cr: 120 >> 83.5
o Restart metformin 1g BD