47year old women with DKA





 47 year old women came to the casualty with cheif complaints of fever and chills 5days ago associated with body pains



47 year old women present to the casualty with C/O of fever and chills since 5 days associated with body pains and generalised weakness.

C/O of vomiting (10episodes)

Vomit was non projectile,non bilious,non particulate



 HOPI:


Patient was apparently assymtomatic 5 days ago and then  she developed the small bleb on the plantar surface of a left foot on which home remedies were practiced and then there was no good result . The patient had episodes of vomiting frequently and even had a complaint of generalised weakness and dehydration.

Fever: high grade a/w chills and rigor

She was diagnosed with type 2 diabetes mellitus 7 years ago and has been on oral hypoglycemics for 5yrs . Later on she  started insulin therapy since 1 year, 20 units morning and 15 units at night .

She under went colonoscopy 3 months ago and was diagnosed with internal hemarroids.

Amputation of the affected region was done 2 days ago.


PAST HISTORY 


No H/O HTN/BA/TB/Epilepsy/Thyroid disorders/CAD/CVA

Diabetic since 7 yrs and started using insulin since 1year.



PERSONAL HISTORY:


Diet- mixed

Appetite- Reduced

Sleep- not Adequate

Bowel and bladder movements- Regular

No known allergies

No addictions


Family history: no significant



GENERAL EXAMINATION:

Patient is Conscious, coherent, cooperative.

No Pallor, icterus, cyanosis, clubbing, koilonychia, lymphadenopathy,

Odema present.

Poor healing of wound over the foot is seen


Vitals:

Temp.- 99.6

BP- 110/70 mmHg

PR- 90bpm

RR- 17cpm

SpO2- 98%

GRBS- 

20/1/21

8:00am - 245mg/dl

2:00pm - 289mg/dl















SYSTEMIC EXAMINATION:


CVS- S1 S2 heard, no murmurs

RS- BAE+ NVBS+

P/A- Soft, Non-tender

CNS- NAD

NO organomegaly

Kusumal breathing seen




INVESTIGATIONS.

CBP-


HB-9.3gm/dl

TLC-16500cells/cumm

PLATELETS-2.4lakhs/cumm

PCV-28.7vol%

MCV-60.3fl

MCH-19.5pg

RBC-4.7million/cumm


IMPRESSION  : MICROCYTIC HYPOCHROMIC ANAEMIA WITH LEUCOCYTOSIS



SERUM ELECTROPHORESIS.                                  


SODIUM-136mEq/L                                                 

POTASSIUM-4.1mEQ/L.                                              

CHLORIDE-101mEQ/L



RFT


URIC ACID - 2mg/dl

CREATININE-0.6mg/dl

UREA - 20mg/dl






USG ABDOMEN : NORMAL

















ECG : TACHYCARDIA
ECHO: CONCLUSION-DIASTOLIC DYSFUNCTION +
GOOD LV SYSTOLIC FUNCTION





GRBS




PROVISIONAL DIAGNOSIS:-

Diabetic ketoacidosis (secondary to infection) with 

left lower limb cellulitis & internal hemorrhoids.

TREATMENT:-

IVF NS 3L FOR 3HRS @150ML/HR.

INJ PAN 40MG IV/OD.

IVF 5%DEXTROSE 50-100ML/HR.

INJ OPTINEURON 1AMP IN 100ML NS/IV/OD OVER 30MINUTES.

INJ HAI 0.1IU/IV/KG WEIGHT IV BOLUS.

INJ NEOMOL 1g/IV/SOS.

INJ ZOFER 4MG/IV/TID.

STRICT BP,PR,TEMP MONITORING.

GRBS MONITORING HOURLY

STRICT LOWER LIMB ELEVATION



  



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