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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 

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