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19 yr old with DKA



A 19 year old  male patient from miryalguda studying Degree first year has come to the   Opd with chief complaints of


Vomiting since 3 days

Shortness of breath on 24th march

Chest pain on 24 th march 

Hopi

Patient was apparently asymptomatic one and half yr ago,then in the 1st 6 months -he noticed gradual loss of weight ,patient had history of polyuria,nocturia,polydypsia https://nikithaedam48.blogspot.com/2021/06/18-year-old-malefrom-miryalagudawho-is.html?m=1

He was diagnosed as Diabetic and during the hospital  stay on day 5 he went to coma for 7 days, then recoverd which was due to acute fulminant hepatic failure   . And discharged after 20 days

4 months back he developed vomitings , which was projectile type , food and water as it’s content 


Now ,

Vomiting are 2-3 episodes /day , projectile, food and water as contents non bilious and not blood tinged

SOB: insidious in onset, patient feels like  it’s due to increased sugar levels and decreased on taking insulin 

Chest pain: pain over sternum and epigastric region which is diffused and burning type generally followed by vomiting no aggrevating and relieving factors 

Past history:

K/c/o DM 

No asthma TB epilepsy hypertension 

Personal history :

Diet - mixed

Appetite - normal

Sleep- adequate 

Bowel and bladder moments are regular

No addictions

 Treatment history

Insulin injection

After breakfast- 52 units

After lunch- 26 units

After dinner- 52 units









General examination 




Patient conscious , coherent , cooperative, and well oriented to time place person.

Moderately built and moderately nourished 

Height:5’5

Weight: 75kg

BMI:: 26.89 (overweight)

No pallor 

No icterus

No cyanosis 

No  generalized lymphadenopathy

No clubbing 


VITALS:

Temperature - 98f

PR-80bpm

RR-18cpm

Bp-110/80 mm of Hg



SYSTEMIC EXAMINATION:


GIT

INSPECTION 

 Shape of abdomen - distended 

Umbilicus - transverse slit like

Moments - all quadrants equally  moving with respiration

Skin over abdomen- normal

No visible gastric peristalsis , intestinal peristalsis

No visible superficial veins

PALPATION

No rise in temperature and no tenderness in all quadrants 

LIVER: no hepatomegly

SPLEEN- not enlarged 

KIDNEYS - bimodal palpable kidneys 

PERCUSSION 

Liver span- 11cm

no shifting dullness

AUSCULTATION 

Bowel sounds are heard and are normal

No bruit

Other system examination : 

RESPIRATORY- bilateral air entry is present

CVS- s1 s2 heard 

CNS - no abnormality 

INVESTIGATIONS 













ECG

USG




Treatment 





25/3/22

10 am - 119  HAI @ 5 ml / hr

11am - 190 HAI @ 5 ml/ hr

12 pm - 239  HAI @ 5 ml/ hr

1pm-166.    HAI @ 5 ml/hr

2pm - 143. HAI @ 5 ml / hr

5pm - 74.   HAI @ 5ml / hr ( D5 @ 100 ml / hr)  

6 pm - 258 HAI @ 5ml/ hr 

8pm - 202  HAI @ 5 ml / hr

10 pm - 229 HAI @ 5 ml/ hr

26/3/22

12 am - 190 HAI @ 5 ml/ hr

4 am - 180 HAI @ 5 ml/hr

6 am -264 HAI @ 5 ml/ hr

8 am 291  HAI @ 5 ml / hr

10am - 256 HAI @ 5 ml/ hr


Provisional Diagnosis :Diabetic ketoacidosis with k/c/o type 1 DM, ?  MISC post COVID ( July 2021) 


P: 

IVF - NS,  RL @ 100ml / hr

Inj. HUMAN ACTRAPID 40U in 39ml NS @ 5 ml /hr 

Nill by mouth 

Inj.  PANTOP 40 mg IV / OD 

Inj. Zofer 4mg IV /TID 

INJ. NEOMOL 1 gm IV /SOS ( if temp > 101 F)  

Tab.  DOLO 650 mg PO/ TID

Inj. 5% dextrose 50 ml / hr ( if grbs< 250) 


Investigations : 

ABG : 

25/03/22.              26 / 03/22

pH : 7.10.              pH : 7.3 

 pCO2 : 6.0.          pCO2 : 26.8 

HCO3 : 1.8.           HCO3 : 13.9 


SO2 : 96.0.            SO2 : 96. 0

PROVISIONAL DIAGNOSIS

Uncontrolled Diabetes mellitus  with Diabetic keto acidosis 














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