Brief Answer:
Serum Ca & electrolytes to be checked immediately

Detailed Answer:
Hi, thanks for posting your concern in the HCM.

My understanding is, all the symptoms you mentioned occur during hypocalcemia, i.e. when there is low serum calcium. Although you are on diuretic for hypertension and aged more than 60 years, you have not been having any calcium and vitamin d supplement. There may be other electrolyte abnormalities also, associated with this.

My suggestion is, please have the following investigations done at the earliest-
Complete blood count, urea, creatinine, electrolytes, serum Ca, Mg, Phosphate, Vit D, LFT
ECG
Urine for routine examination
Please upload the reports of the tests that you have already done.

You should visit the ER of your local hospital at the earliest for these evaluation and further management so that prompt treatment can be initiated to avoid severe neuromuscular or cardiac complications.

However, if finally diagnosed with hypocalcemia, any aggressive correction of calcium should not be done because the condition is chronic and sudden correction would result in fatal manifestations of hypercalcemia. If needed sodium and potassium would also have to be corrected my revising treatment regimen and fluid management.

For any further information, please write back.
Regards.
Dr. Kaushik

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Brief Answer:
Vit D deficiency is responsible

Detailed Answer:
Hi, thanks for your reply.
But, I couldn't read your report because the attached .pdf file was password protected and you didn't mention your password.
However, from the information you provided, it is understandable that the persistent Vit D deficiency may cause calcium deficiency.
Usually, Hydrochlorthiazide increases serum calcium and reduces urinary excretion of calcium. So, this is helpful if there is calcium deficiency. However, it can reduce the level of other electrolytes like sodium and potassium. So, tests are needed to check their levels too.
Other medications for hypertension, i.e. telmisartan and Starpress XL won't cause severe calcium deficiency.
So, now we know the cause. Treatment of Vit D deficiency alongwith calcium supplementation can solve the problem.
So, none of your medications is responsible for this problem of calcium deficiency. Please continue taking the antihypertensives as before.
If you find this answer helpful, please close the thread and rate my answer.
Regards.

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Brief Answer:
Vit D deficiency treament

Detailed Answer:
Vit D deficiency can be corrected by one of the below mentioned two regimens:

50,000 IU of vitamin D2 or D3 once weekly for 8 weeks
or
6000 IU/day of vitamin D2 or D3 for 8 weeks

Maintenance treatment - 1500-2000 IU/day. Maintenance treatment should begin when the serum 25(OH)D level exceeds 30 ng/mL.
You haven't mentioned your height and weight. Hence, I couldn't calculate your BMI. So, I don't know whether you have normal body weight or you are obese.

Recommended treatment for vitamin D–deficient patients who are obese:

At least 6000-10,000 IU of vitamin D daily
When the serum 25(OH)D level exceeds 30 ng/mL, maintenance treatment of 3000-6000 IU/day

Furthermore, you have dyslipidemia. A strict diet control, with low fat (restrict oil intake to 2 tablespoon/day) high fibre diet, and regular exercise should be continued for at least 3 months and then the lipid profile should be repeated. If the report still shows any problem, you would need regular medication for dyslipidemia.
You should also check your HbA1c level. Your fasting sugar is borderline high. Please maintain diabetic diet.
Your liver enzymes are also raised. Further evaluation is needed for that. You should consult a local gastroenterologist. You need to have an USG upper abdomen and viral screening for hepatitis. Please avoid alcohol for at least 3 months.
Moderate fluid restriction, upto 1.5 lit/day is needed for a couple of days. The serum sodium needs to be checked again after that. If the hyponatremia persists please consult your local physician.
If you are satisfied with this answer, please close the thread and rate my answer.
Regards.
Dr. Kaushik Sarkar

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Brief Answer:
medication for hypertension and dyslipidemia

Detailed Answer:
Thanks for consultation for follow up.
Before I answer your question, I need to clarify a few things.
Firstly, you have diabetes, your 2hr post meal glucose level is quite high and you have been rightly given Janumet. But, the treatment of diabetes should be based on HbA1c level. You have to check it for proper management as per national and international guidelines.
Secondly, your dyslipidemia has worsened from the past. Now, you need medications alongwith lifestyle modifications to control it and to prevent atherosclerosis and consequent heart disease. You may start with Tab Atorvastatin 10 mg with strict salt restricted diabetic diet. You also need to do exercise for at least one hour per day.
Finally, regarding your question on antihypertensive medicine, I think you should start with Tab Telma 40 mg now in the morning. Without medicine the blood pressure will shoot. Check blood pressure twice daily at 8am and 8pm. Make a chart of that with 7days data and report back. If blood pressure is below 100/60 mm of Hg, just skip the medicine. This will simultaneously prevent shooting of your blood pressure or sudden fall.
If you find this answer helpful, please close the thread and rate my answer.

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Brief Answer:
May be due to depression

Detailed Answer:
Hi, thanks for posting the concern again.
Dr. Chopra was absolutely right in prescribing you the medications and advising for checking glucose after a week.
Now, the problem seems to be due to your mood disorder. Diabetes patients especially presents with similar sort of fluctuations in mood in the initial stage.
You need to do regular exercise, maintain sleep hygiene (going to bed at fixed time every day, sleep for 8 hours).
You should also check your Serum electrolytes level. If they are in normal range no need to worry. Follow advice of Dr. Chopra.
Wish you a very good health.
Regards

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Brief Answer:
walking, diabetic diet

Detailed Answer:
Yes, I have seen the reports. As a diabetic patient, your report is good. You have good control. The target is below 7 for diabetes patients and you have to maintain that. Regarding exercise walking for an hour or so would suffice. Regarding diet, a few things you need to keep in mind.
1. Restrict salt to less than 5gm per day (for hypertension)
2. Avoid junk food, carbonated beverages, smoking and alcohol.
3. Restrict oil to less than 2tablespoons per day.
4. Consume large amount of green leafy vegetables, high fibre diet.
5. Avoid large amount of potatoes when you are having rice or bread for meals. That means you need to restrict refined carbohydrates and meet your hunger with more vegetables and protein containing food. Animal proteins are preferred like fish, chicken etc.
6. Avoid egg yolk to reduce cholesterol.
7. Drink plenty of oral fluid.
8. Breakfast should be larger in amount than lunch and lunch should be larger than dinner. You may also break meals into small portion. Eat small frequent meals.
9. One citrus fruit of 100 gm can be consumed everyday.
10. Eat whole fruit after washing rather than fruit juice.
11. Avoid ghee, butter.
12. Most importantly avoid stress. This is not part of the dietary advice. I am writing it here for greater emphasis. Stress is worse than smoking, alcohol, sweets etc. So, don't get stressed out.
13. If you ever have sweating, chest pain or altered consciousness rush to the nearest emergency.
Take care of your lifestyle and it will take care of your health. Believe me, you are doing well and if you have good control, you will live a normal life.
Please also check your eye and hearing annually to local consultant. 6 monthly check up of lipid profile should also be done. HbA1c should be done at every 3 months. BP should be checked every month even if you are asymptomatic.
Enjoy your life and whenever there is a problem, feel free to ask me.
Regards,
Dr Kaushik Sarkar

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