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List the test
Here are the tests listed in the handwritten note (scheduled for Tomorrow):
- CRP (C-Reactive Protein)
- Sr. Creatinine (Serum Creatinine)
- Sr. Electrolytes (Serum Electrolytes)
- CXR PA view (Chest X-Ray - Posteroanterior view)
DM ON OHA
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"oral hypoglycemic agents" AND "type 2 diabetes" AND management
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DM on OHA - Explained
DM on OHA = Diabetes Mellitus currently being treated with Oral Hypoglycemic Agents (also called oral antidiabetic drugs / OADs). This is standard clinical shorthand in case notes indicating the patient has Type 2 DM managed without insulin.
Classes of OHA (Oral Hypoglycemic Agents)
| Drug Class | Examples | Key Feature |
|---|---|---|
| Biguanides | Metformin | First-line; weight neutral/loss; low hypoglycemia risk |
| Sulfonylureas | Glipizide, Glibenclamide, Glimepiride | High efficacy; causes weight gain; moderate hypoglycemia risk |
| Thiazolidinediones (TZD) | Pioglitazone | High efficacy; causes edema, weight gain; risk of heart failure |
| DPP-4 Inhibitors | Sitagliptin, Vildagliptin | Intermediate efficacy; weight neutral; low hypoglycemia risk |
| SGLT-2 Inhibitors | Empagliflozin, Dapagliflozin | Weight loss benefit; cardioprotective; risk of genitourinary infections |
| GLP-1 Receptor Agonists | Liraglutide, Semaglutide | High efficacy; weight loss; GI side effects |
Step-Up Approach (ADA guidelines)
- Monotherapy - Start with Metformin (unless HbA1c >9%, then start dual therapy directly)
- Dual Therapy - Add a second agent if HbA1c target not met in ~3 months
- Triple Therapy - Add a third agent if still not at target
- Injectable therapy - Move to basal insulin or GLP-1-RA if oral triple therapy fails
Clinical Significance in This Patient
Given the context of the case note (fever, cough, SpO2 97%, on IV Meropenem - suggesting an active infection/pneumonia), the OHA status is important because:
- Active infections cause insulin resistance - blood glucose may be harder to control on OHA alone
- Severe illness/infection may warrant temporary switch to insulin for better glycemic control
- Metformin is typically held during acute illness (risk of lactic acidosis, especially if contrast is needed for imaging like CT)
(Source: Symptom to Diagnosis, 4th Ed., Table 12-10)
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