25M with type 1 DM with Diabetic nephropathy with DKA and old inferior wall MI

DOA : 7/2/2023
Discharge Date
Date:
Ward: AMC
Unit:GENERAL MEDICINE II

Diagnosis
DIABETIC KETOACIDOSIS (RESOLVED)
OLD INFERIOR WALL MYOCARDIAL INFARCTION
K/C/O TYPE I DM SINCE 9 YEARS WITH DIABETIC NEPHROPATHY
Case History and Clinical Findings
PRESENTING COMPLAINTS :FEVER SINCE 1 WEEKVOMITINGS SINCE 1 WEEK
DRYNESS OF MOUTH SINCE 1 WEEKCHEST PAIN SINCE 1 WEEKPALPITATIONS SINCE 1 WEEKSHORTNESSOFBREATHSINCE1WEEK


HISTORY OF PRESENTING ILLNESS:
PATIENT WAS APPARENTLY ASYMPTOMATIC ONE WEEK BACK THEN HE DEVELOPEDFEVER OF HIGH GRADE WITH CHILLS, INSIDIOUS IN ONSET, GRADUALLY PROGRESSIVE,NOT RELIEVED ON TAKING MEDICATION.
ASSOCIATED WITH VOMITINGS CONTAINED FOOD PARTICLES, NON BILIOUS, NONPROJECTILE, 3-4 EPISODES/DAY , ASSOCIATED WITH DRYNESS OF MOUTH.
H/O CHEST PAIN, LEFT SIDED, PRICKING TYPE, NON RADIATING ASSOCIATED WITH SOBGRADE 3, INSIDIOUS IN ONSET GRADUALLY PROGRESSIVE.
NO H/O ORTHOPNEA.
H/O BLURRING OF VISION PRESENT IN RIGHT EYE.NO H/O PAIN ABDOMEN
NO H/O DIZZINESS, ALTERED SENSORIUMNO H/O DECRESED URINE OUTPUT

PAST HISTORY :K/C/O DM I SINCE 8 YRS (DIAGNOSED AT THE AGE OF 17YRS) AND ONBIPHASIC ISOPHENE INSULIN INJECTION( 30% SOLUBLE INSULIN AND 70% ISOPHENEINSULIN) 24U IN THE MRNG AND 20U IN THE NIGHT.
NOT A K/C/O HTN / ASTHMA / CAV / CAD


PERSONAL HISTORY :
SLEEP: ADEQUATEAPPETITE: NORMALDIET: MIXED
BOWEL AND BLADDER MOVEMENTS: NORMALADDICTIONS: NONE

FAMILY HISTORY :
NO SIMILAR COMPLAINTS IN FAMILY

GENERAL EXAMINATION :PATIENT IS CONSCIOUS, COHERENT, COOPERATIVEMODERATELY BUILT AND WELL NOURISHED
PALLOR - ABSENTICTERUS - ABSENTCLUBBING - ABSENTCYANOSIS-ABSENT
LYMPHADENOPATHY - ABSENTEDEMA - ABSENT

VITALS:
TEMP-96.5 FPR-82/MINRR-14/MIN
BP-110/70MMHG
SPO2-99% AT ROOM AIRGRBS-197MG%.

SYSTEMIC EXAMINATION :
CVS - S1S2 PRESENT, NO MURMUR
RS - BILATERAL AIR ENTRY PRESENT, TRACHEA CENTRAL IN POSITIONCNS - HIGHER MENTAL FUNCTIONS INTACT
P/A - SOFT, NON TENDERCOURSE IN HOSPITAL :
DAY 1 :
PATIENT PRESENTED TO THE HOSPITAL WITH ABOVE MENTIONED COMPLAINTS , ONCLINICAL EXAMINATION AND NECCESARY INVESTIGATIONS PATIENT WAS FOUND TO HAVEDIABETIC KETOACIDOSIS WITH OLD INFERIOR WALL MI WITH K/C/O DM 1 FOR WHICHSYMPTOMATIC TREATMENT WAS GIVEN WITH
IV FLUIDS NS@75ML/HR 5% DEXTROSE IF GRBS <= 250MG/DL
INJ HUMAN ACTRAPID INSULIN 6UNITS IV STAT
INJ HUMAN ACTRAPID INSULIN IN @ 6ML/HR
TAB ECOSPRIN 325MG PO STAT
TAB CLOPIDOGREL 300MG PO STAT
TAB ATORVAS 80MG PO STAT
TAB ECOSPRIN GOLD 75/75/10MG PO HS
GRBS MONITORING HOURLY
STRICT I/O CHARTING.
VITALS MONITORING 2ND HRLY.


DAY 2 :
PATIENT COMPLAINTS OF NO STOOL PASSED AND HE WAS GIVEN SYMPTOMATICTREATMENT ACCORDINGLY WITH ADDED
SYP POTKLOR 10ML PO TID WITH ONE GLASS OF WATER IN VIEW OF HYPOKALEMIA.NEPHROLOGY OPINION WAS TAKEN IN VIEW OF PROTEINURIA OF 2400MG/DAY AND CUESHOWINGALBUMINOF+3.THEYADVICEDDIABETICNEPHROPATHY,TABTELMA40MGPO
OD , BLOOD SUGAR CONTROL.
OPHTHALMOLOGIST OPINION WAS TAKEN IN VIEW OF DIABETIC RETINOPATHY. THEYADVICED NO DIABETIC RETINOPATHY CHANGES NOTED

DAY 3 :PATIENT WAS GIVEN SYMPTOMATIC TREATMENT ACOORDINGLY AND PATIENTCONDITION IMPROVED.
INJ NPH 20U--20U--20UINJ HAI 14 14U

DAY 4:
PATIENT WAS GIVEN SYMPTOMATIC TREATMENT. AT THE TIME OF DISCHARGE THECONDITION OF THE PATIENT IS IMPROVED AND BEING DISCHARGED IN AHEMODYNAMICALLY STABLE CONDITION.
INJ NPH 20U--20U--20UINJ HAI 14 14U

Treatment Given(Enter only Generic Name)
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.

Investigations
7-02-2023 (3:55 pm)
ABG- 
PH 7.19
PCO2 12.0
PO2 125
HCO3 4.5
St.HCO3 9.7
BEB -23.6
BEecf -22.7
TCO2 8.7
O2 Sat 97.6
O2 Count 27.5

COMPLETE URINE EXAMINATION (CUE):
COLOUR  -Pale yellow
APPEARANCE -Clear
REACTION Acidic
SP.GRAVITY 1.010
ALBUMIN +++
SUGAR +
BILE SALTS Nil
BILE PIGMENTS Nil
PUS CELLS 2-4
EPITHELIAL CELLS2-3
RED BLOOD CELLSNil
CRYSTALS Nil
CASTS Nil
AMORPHOUS -Absent
DEPOSITS
OTHERS Nil

HBsAg-RAPID -Negative
Anti HCV Antibodies -Non Reactive
SERUM ELECTROLYTES
 SODIUM -133 mEq/L
POTASSIUM -4.1 mEq/L
CHLORIDE -106 mEq/L
CALCIUM IONIZED   - 1.12 mmol/L

LIVER FUNCTION TEST (LFT)   
Total Bilurubin 1.28 mg/dl
Direct Bilurubin 0.4 mg/dl
SGOT(AST) 27 IU/L 
SGPT(ALT) 25 IU/L
ALKALINE  PHOSPHATE -261 IU/L
TOTAL PROTEINS 6.6 gm/dl
ALBUMIN 4.0 gm/dl
A/G RATIO 1.59

ABG (7/02/2023 ,6:35 pm)
PH 7.25
PCO2 26.3
PO2 34.5
HCO3 11.3
St.HCO3 13.3
BEB -14.4
BEecf -14.5
TCO2 23.2
O2 Sat 76.0
O2 Count 14.9


BLOOD UREA-44 mg/dl
SERUM CREATININE -0.9 mg/dl
PHOSPHOROUS  -2.0mg/dl

8/02/2023
BLOOD UREA   - 34 mg/dl
SERUM CREATININE -0.7 mg/dl

SERUM ELECTROLYTES 
SODIUM 124 mEq/L
POTASSIUM 3.3 mEq/L
CHLORIDE 102 mEq/L
CALCIUM IONIZED    1.10 mmol/L
ABG08-02-2023 05:16:AM
PH 7.32
PCO2 25.2
PO2 112
HCO3 12.7
St.HCO3 16.0
BEB -11.3
BEecf -12.2
TCO2 23.9
O2 Sat 97.2
O2 Count 25.5

ABG (8/02/2023 - 4:29 pm)
PH 7.38
PCO2 27.7
PO2 112
HCO3 16.1
St.HCO3 19.0
BEB -6.9
BEecf -8.1
TCO2 29.9
O2 Sat 97.7
O2 Count 25.2

SERUM ELECTROLYTES (08-02-2023 05:04:PM)
SODIUM 136 mEq/L
POTASSIUM 2.9 mEq/L
CHLORIDE 107 mEq/L
CALCIUM IONIZED    1.29 mmol/L

09-02-2023 01:11:AM
 BLOOD UREA -37 mg/dl
SERUM CREATININE - 0.6 mg/dl
SERUM ELECTROLYTES 
SODIUM 144 mEq/L
POTASSIUM 4.4 mEq/L
CHLORIDE 106 mEq/L
CALCIUM IONIZED    1.30 mmol/L
09-02-2023 05:33:AM
ABG : 
PH 7.36
PCO2 28.5
PO2 43.7
HCO3 16.0
St.HCO3 18.5
BEB -7.3
BEecf -8.3
TCO2 30.2
O2 Sat 89.3
O2 Count 22.4

10/02/2023 12:45 pm
BLOOD UREA- 32 mg/dl
SERUMCREATININE -0.7 mg/dl
SERUM ELECTROLYTES 
SODIUM 138 mEq/L
POTASSIUM 2.8 mEq/L
CHLORIDE 106 mEq/L
CALCIUM IONIZED    1.21 mmol/L

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