General medicine e- log 16/03/2021
A CASE OF DIABETIC KETOACIDOSIS WITHNACUTE ON CHRONIC PANCREATITIS
This is 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 patients cl29yr male presented to the casuality with the chief complaints of
Pain abdomen since oneday
Vomitings since one day
He was apparently asymptomatic 2yrs ago.. Then he developed pain abdomen for which he visited local hospital and received medication.. At that time only, he was told to have diabetes and he is on regular medication (Met -500) since then he is having on and off symptoms every 2-3 months and received medication for 3days. .
On friday, (16/03/2021) he attended a function where he had spicy food and alcohol, then developed pain abdomen in the epigastric region progressive along with vomitings non projectile non bilious. For which he visited local hospital and was told to have ketone bodies in the urine. They referred to kims narketpally
Past history :
K/c/o DM ( on medication)
Not ak/c/o HTN, EPILEPSY, TB, ASTHMA CVD
Family history :
Not significant
Personal history :
Mixed diet
Appetite normal
Sleep adequate
He consumes alcohol every 2-3 days, 180ml, whisky since 10yrs
Smoking cigarettes. (5) during time of alcohol consumption since 10yrs.
No known allergies
General EXAMINATION :
PT is conscious, coherent, cooperative, well oriented to time place and person
no pallor
No icterus
No cyanosis
No clubbing
No pedal edema
No generalised lymphadenopathy
Vitals :
BP 130/90
PR 126bpm
temp: AFEBRILE
SpO2 98%
GRBS 484
Systemic Examination :
CVS:
S1 S2 HEARD
No murmurs.
RESP:
BAE +
NVBS +
No adventitious sounds
Per abdomen:
Distended abdomen
Tender
bowel sounds heard
inical problems with collective current best evidence based inputs
CNS
intact
Provisional diagnosis :
Diaabetic ketoacidosis with acite on chronic pancreatitis
Investigations :
Treatement
17/03/2021:
NBM TILL FURTHER ORDERS
IVF- 1 NS BOLUS 3L WITHIN 1 HR OF ADMISSION
IVF NS @250 ML PER HOUR
INJ.HAI 8U IV STAT FOLLOWED BY INJ HAI 1 ML IN 39 ML NS @ 8 ML PER hr IV infusion
GRBS MONITORING HOURLY
STRICT I/O MONITORING
INJ.THIAMINE 200MG IN 100 NS /IV
INJ.OPTINEURON 1 AMP IN 100 ML NS /IV OVER 15 MIN
INJ.ZOFER 4MG IV/SOS
NJ PAN 40 MG IV /OD
18/03/21
IVF. 1 NS ,1 RL @150 ML PER HOUR
NBM TILL FURTHER ORDERS
INJ HAI 1 ML IN 39 ML NS @6ML PER HOUR/IV/INFUSION
INJ.THIAMINE 100 MG IN 100 ML NS /IV/BD
INJ. OPTINEURON 1 AMP IN 100 ML NS /IV/ OD
INJ.ZOFER 4MG IV/SOS
NJ PAN 40 MG IV /OD
INJ TRAMADOL 1 AMP IN 100 ML NS/IV/SOS
STRICT I/O MONITORING
GRBS MONITORING HOURLY
20/03/2021:(COMPLAINTS OF ABDOMINAL TIGHTNESS ,PASSED STOOOS SEMI SOLID ABOUT 5-6 TIMES)
BP: 120/90
PR 96 BPM
P/A SOFT
Rx:
IVF. 1 NS ,1 RL @150 ML PER HOUR
NBM TILL FURTHER ORDERS
INJ HAI 1 ML IN 39 ML NS @6ML PER HOUR/IV/INFUSION
INJ.THIAMINE 100 MG IN 100 ML NS /IV/BD
INJ. OPTINEURON 1 AMP IN 100 ML NS /IV/ OD
INJ.ZOFER 4MG IV/SOS
NJ PAN 40 MG IV /OD
INJ TRAMADOL 1 AMP IN 100 ML NS/IV/SOS
STRICT I/O MONITORING
GRBS MONITORING HOURLY
IV FLUID 5%DEXTROSE @50 ML PER HOUR
