Young adult 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 - 98.8F
PR-94bpm
RR-20cpm
Bp-130/80 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
Treatment
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
