Diabetic ketoacidosis

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 he noticed gradual loss of weight since 6months,patient had history of polyuria,nocturia,polydypsia since 2 monthshttps://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   . Nd discharged after 20 days

4 months back he developed vomitings , which was projectile type , food Nd water as 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: 75

BMI::

No pallor 

No icterus

No cyanosis 

No  generalized lymphadenopathy

No clubbing 


VITALS:

Temperature - 98.6

PR-80

RR-18

Bp-110/80


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

Light palpation- all quadrants are normal, no pain

Deep palpation-  lipodystrophy felt on right iliac fossa 

LIVER:

SPLEEN- not enlarged 

KIDNEYS - bimodal palpable kidneys 

PERCUSSION 

Liver span- 

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


A : 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 

S HCO3 : 6.5.       S HCO3 : 16.7

SO2 : 96.0.            SO2 : 96. 0


Provisional diagnosis: Diabetic ketoacidosis

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