LaoHuang Medical Odyssey

I am kinda guilty for missing the DKA initially in this case. Luckily my boss found my mistake and rectified it. 75 years old lady, underlying hypertension, DM, dyslipidaemia, AF on warfarin, brought in by son, claimed to have 2 episodes of fall, presented with less responsiveness and body weakness. Our initial walking diagnosis is TRO intracranial bleed because of history of fall and history of taking anticoagulant. Further history noted patient had been having poor oral intake for 1 month with abdominal discomfort and loose stool for past few days, however we were too focused on the history of fall, as patient looked drowsy and weak, so we decided to hydrate the patient and send patient for CT brain first.  CT brain was normal. We were thinking it could be some kind of electrolyte imbalance, given the history of poor oral intake and some ongoing loose stool episodes, which makes patient weak and fell down at home.  My EP came for round after lunch, she immediately found something unu

This is definitely one of the most bizarre case I have seen in ETD so far. This patient was referred from private hospital to us after some alleged mismanagement that caused harm to patient. 55 years old uncle, underlying hypertension, diabetes mellitus, history of ischaemic stroke in 2018 without residual weakness, and chronic kidney disease not on dialysis, apparently very bad DM control on OHA and insulin, initially was presented to private hospital late April with bilateral lower limb scalded wound after he soaked his legs into hot water. Bedside debridement was done in private hospital and patient was treated as infected bilateral lower limb scalded wound, because wound swab C+S noted growth of 2 notorious organisms, which are Staph aureus sensitive to cloxacillin and cefepime, and Enterococcus faecalis sensitive to augmentin but resistant to cefepime. He was then started on IV cloxacillin and IV cefepime. However he developed reduced consciousness after started on treatment for 5