Skip to main content

DIABETIC KETOACIDOSIS SECONDARY TO NON-COMPLIANCE

A 50 yr old female came to GM OPD with chief complaints of fever, vomiting, difficulty in breathing.

HISTORY OF PRESENTING ILLNESS:-

patient was apparently asymptomatic 2 weeks back then she developed fever of low grade with vomiting 4 episodes per day which is non-bilious, non-projectile.

HISTORY OF PAST ILLNESS:-

K/C/O- DM since 20yrs
K/C/O- HTN since 20yrs.
Not a K/C/O of TB, ASTHMA, EPILEPSY

TREATMENT HISTORY:-

METFORMIN since 20yrs
TELMISARTAN since 20yrs

PERSONAL HISTORY:-

Diet- mixed
Appetite- normal
Bowel and bladder habits- regular
Burning micturition
No addiction

FAMILY HISTORY:- Not significant

PHYSICAL EXAMINATION:-
#GENERAL:-
No pallor
No icterus
No cyanosis
No clubbing
No lymphadenopathy

Vitals:-
B.p- 140/90mmHg
Pulse- 
Temp- Afebrile
Respiratory rate- 18/min

#Systemic examination:-
CVS- S1,S2 heard
          No cardiac murmurs
          No thrills

Respiratory system- dyspnoea present
                                      No wheeze
                                      Position of trachea -central
                                      Breath sounds-vesicular

Abdomen -shape-obese
                     Tenderness-no
                     No palpable masses 
                     No free fluid
                     Liver not palpable
                     Spleen not palpable
                     Bowel sounds heard


PROVISIONAL DIAGNOSIS:- 

Diabetic Ketoacidosis secondary to non-compliance

INVESTIGATIONS:-

USG Abdomen:-

Bacterial culture and sensitivity:-
Fever chart:-

ECG:-
05/09/23
07/09/23
08/09/23

10/09/23
11/09/23
12/09/23

Treatment:-
05/09/23
1.Inj. HAI 1ml
   In 39ml NS @6ml/hr
2.TAB ECOSPORIN 

06/09/23
1.IV fluid NS 75ml/hr
2.Inj. PANTOP 40mg (IV) once daily
3.Inj. ZOFER 4mg IV 
4.PCM 650mg
5.TAB ECOSPORIN
6.Inj. PIPTAZ 2.25g IV TID
7.Inj. LASIX 40mg
8.TAB TELMIKIND 40mg

07/09/23
1.Inj. HAI 1ml
   In 39ml NS @1ml/hr
2.Inj. PANTOP 40mg IV once daily
3.IV fluid 0.45% NS @50ml/hr
4.Inj. PIPTAZ 2.25g IV TID
5.Inj. NEOMOL 1g IV
6.TAB PCM 650mg
7.TAB ECOSPORIN 75mg once daily
8.Inj. LASIX 40mg
9.TAB TELMIKIND 40mg

08/09/23
1.Inj. PIPTAZ 2.25g IV TID
2.Inj. PANTOP 40mg IV once daily
3.Inj. LASIX 40mg
4.Inj. NEOMOL 1g IV
5.TAB TELMIKIND 40mg
6.TAB ECOSPORIN 75mg once daily

09/09/23
1.Inj. PANTOP 40mg IV once daily
2.Inj. PIPTAZ 2.25g IV TID
3.Inj. NEOMOL 1g IV
4.TAB ECOSPORIN 75mg once daily
5.Syrup LACTULOSE 
6.Inj. LASIX 40mg

10/09/23
1.Inj. PANTOP 40mg IV once daily
2.Inj. PIPTAZ 2.25g IV TID
3.Syrup LACTULOSE
4.Inj. LASIX 40mg
5.TAB ECOSPORIN 75mg once daily
6.TAB TELMIKIND 40mg

11/09/23
1.Inj. PIPTAZ 2.25g IV TID
2.Inj. PANTOP 40mg IV once daily
3.Inj. NEOMOL 1g IV
4.Inj. ZOFER 4mg IV
5.TAB TELMIKIND 40mg 
6.TAB ECOSPORIN 75mg once daily
7.Syp. LACTULOSE 10ml oral BID
8.Inj. LASIX 40mg
9.Inj. ERYTHROPOIETIN S/C

12/09/23
1.Inj. PIPTAZ 2.25g IV TID
2.Inj. PANTOP 40mg IV once daily
3.Inj. NEOMOL 1g IV
4.Inj. LASIX 40mg
5.Inj. ZOFER 4mg IV
6.TAB ECOSPORIN 75mg once daily
7.TAB PCM 650mg 
8.Syp. LACTULOSE 10ml oral BID

13/09/23
1.Inj. PIPTAZ 2.25g IV TID
2.Inj. PANTOP 40mg IV once daily
3.Inj. LASIX 40mg
4.Inj. NEOMOL 1g IV
5.Inj. ZOFER 4mg IV
6.TAB ECOSPORIN 75mg once daily
7.TAB PCM 650mg
8.Syp. LACTULOSE 10ml oral BID
9.Syp. ALKASTON B-6 15ml BID
10.Neb. SALBUTAMOL 

14/09/23
1.Inj. PIPTAZ 2.25g IV TID
2.Inj. PANTOP 40mg IV once daily
3.Inj. LASIX 40mg
4.Inj. NEOMOL 1g IV
5.TAB PCM 650mg
6.Syp. LACTULOSE 10ml oral BID
7.Neb. SALBUTAMOL 

Comments

Post a Comment

Popular posts from this blog

  CASES IN GENERAL MEDICINE A 45 yr old male is a chronic alcoholic since 20 yrs carpenter by occupation was brought to causality in a state of altered sensorium since 1 day . Hi, I am Ankesh Kumar Sahu is a medical student. This is an online E logbook to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. This E-log book also reflects my patient-centered online learning profile and your valuable inputs on the comment box are welcome. I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations, and come up with a diagnosis and treatment plan. CHIEF COMPLAINTS   • Difficulty in walking&decreased appetite since 15 days •Constipation since 5 days •Fever and pedal edema since 3 days •Vomiting since 2 days HISTORY OF PRESENT ILLNESS •Pat...
Post a Comment
Read more
  CASES IN GENERAL MEDICINE 41-YEAR-OLD MALE PATIENT WITH A HISTORY OF FEVER AND ALTERED SENSORIUM   Hi, I am Ankesh Kumar Sahu a medical student.  This is an online E logbook to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent.  This E-log book also reflects my patient-centered online learning profile and your valuable inputs on the comment box are welcome.   I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations, and come up with a diagnosis and treatment plan. CASE DISCUSSIOn CASE: - 41year old male resident of Chalakurthy p resented to the OPD in summer 2021 with c hief complaints of  Fever - Since 2 days. Altered sensorium with irrelevant talk- Since 1 day.   HISTORY OF PRES...
Post a Comment
Read more
A 45 YEAR  FEMALE WITH FEVER, VOMITING AND SHORTNESS OF BREATH This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.  Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.  This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.” I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan. A 45year female Presented with  C/O Fever since 5 days C/O Vomiting since 4 days C/O Headache since 4 days C/O Shortn...
Post a Comment
Read more