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

DIMINUTION OF VISION IN THE EYES

A male patient of age 77 years old resident of vangamurthy presented to the opd with chief complaints of  1) diminution of vision in both eyes since 2 years  HISTORY OF PRESENTING ILLNESS:- Patient was apparently asymptomatic 2 months ago and he developed diminution of vision which was insidious in onset and gradually progressive in nature .  It was not associated with watering , photophobia , redness or itching .  HISTORY OF PAST ILLNESS:- There was a history of surgery related to CHD 1 year ago  There was a history of auditory and visual hallucinations since 1 year and was diagnosed 1 month ago . K/C/O of DM 2 since months  Not K/C/O of asthma , epilepsy , Tb  TREATMENT HISTORY:- 1)  Metformin 500 mg  2) risperidone 2 mg  PERSONAL HISTORY:- Sleep : inadequate  Appetite : loss of appetite  Bladder and bowel : regular  Drug allergies : no  Addictions : no  FAMILY HISTORY:- Not significant PHYSICAL EXAMINATION:- ...
Post a Comment
Read more
BIMONTHLY ASSIGNMENT OF MEDICINE FOR JUNE 2021 QUESTION 1:-   https://medicinedepartment.blogspot.com/2021/06/medicine-department-paper-for-june-2021.html?m=1 1) INFECTIOUS DISEASE (COVID-19) PATIENT DETAILS:   https://nikhilasampathkumar.blogspot.com/2021/05/covid-pneumonia-in-pre-existing-case-of.html REVIEW FOR THE LINK: https://meesumabbas82.blogspot.com/2021/05/case-opinions-may-2021.html #Explained about Importance of ILD in the prognosis of COVID Patients. Provided reference link to study about effects of using steroids in COVID patients ( https://www.health.harvard.edu/blog/does-lupus-or-arthritis-affect-your-prognosis-if-you-get-covid-19-2020110921230#:~:text=There%20was%20some%20good%20news,prognosis%20for%20the%20arthritis%20patients .) #Role of the autoimmune response in COVID Patients ( https://www.healio.com/news/rheumatology/20210329/covid19-more-severe-than-influenza-in-patients-with-autoimmune-disease ) PERFORMANCE: - 9/10   ...
Post a Comment
Read more
  BIMONTHLY ASSIGNMENT OF MEDICINE FOR JULY 2021 BELOW IS THE LINK TO THE QUESTIONS ASKED TO US:- http://medicinedepartment.blogspot.com/2021/07/medicine-paper-for-july-2021-bimonthly.html?m=1 QUESTION 1:- Below is the link of the student for which I am giving my peer review. https://www.google.com/url?q=https://www.google.com/url?q%3Dhttps://angasanvith09.blogspot.com/2021/07/general-medicine-assignment.html%26amp;sa%3DD%26amp;source%3Deditors%26amp;ust%3D1626285857750000%26amp;usg%3DAOvVaw1I_MGzhIo0PPVtxipHNTa3&sa=D&source=editors&ust=1626285858217000&usg=AOvVaw1DbqqMfufy_38kPpzIaX2r Reviews to all the questions answered:- 1) The reviews for the cases selected are well described. A detailed pinpoint review has been given to each particular case selected, which is helpful in easy analysis.  Even though the peer reviews giving are short they are well described. 2)He  went with good investigations and given a better explanation for every case. Even every ...
Post a Comment
Read more