1801006130 -Short case

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25 YR OLD MALE WITH CHEST PAIN, VOMITINGS AND SOB 

History of presenting illness :

patient was  apparently asymptomatic 9 years back,

Patient c/o blurring of vision for which he went to local hospital used medication but his blurring of vision(Rt>>Lt) wasn't subsided 

In 2014 patient c/o severe weight loss approximately 10-12 kgs over a duration of 2 months. And having increased apetite, increased frequency of urination with these complaints he went to Local hospital and diagnosed with type 1 diabetes mellitus and since then he was started on Mixtard insulin 28U -x - 24U and since then he is on regular follow up.. His fbs used to be around 200-250 and ppbs around 250-300

Last HbA1c was 11.2 on previous check up 

Now since 1 week patient came with c/o fever high grade associated with chills and rigors, Nausea, Vomitings , constipation

And c/o neck pain

No c/o chest pain palpitations , syncopal attacks 

No meningeal signs 

At presentation his grbs is 234 mg/dl with urine for ketones ++ 

Outside 24hr urine proteins 3920mg/day 

 Past history:

Not a k/c/o HTN / Asthma / CAV / CAD

Personal history :

Sleep: adequate 

Appetite: normal 

Diet: mixed

Bowel and bladder movements: normal 

Addictions: none 

Family history : 

No similar complaints in family 

General examination :

Patient Is conscious, coherent, cooperative moderately built and well nourished 

pallor - Absent 

icterus - Absent

clubbing - Absent

cyanosis - Absent

lymphadenopathy - Absent

Edema - Absent

Vitals:

TEMP-96.5 F

PR-82/MIN

RR-14/MIN

BP-110/70MMHG

SPO2-99% AT ROOM AIR

GRBS-197MG%. 

Systemic examination :

CVS - S1S2 present, no murmur

RS - Bilateral air entry present, trachea central in position 

CNS - Higher mental functions intact 

P/A - Soft, non tender

Usg abdomen :

Echo :

Blood and urine investigations:

ECG :

Provisional Diagnosis :

DIABETIC KETOACIDOSIS(RESOLVED) WITH OLD INFERIOR WALL MI WITH K/C/O TYPE I DM SINCE 9YRS WITH DIABETIC NEPHROPATHY 

 

Treatment :

* IV FLUIDS NS@75ML/HR

 5% DEXTROSE IF GRBS <= 250MG/DL

* HUMAN ACTRAPID INSULIN INFUSION ( 1ML +39 ML NS) @ 3ML/HR BASED ON GRBS 

* TAB ECOSPRIN GOLD 75/75/10MG PO HS  

* GRBS MONITORING HOURLY

* STRICT I/O CHARTING.

* VITALS MONITORING 2ND HRLY.