14F DKA ; T1DM Since 4Y
Case History and Clinical Findings
PATIENT CAME TO THE CASUALTY WITH CHIEF COMPLAINTS OF:
1. SHORTNESS OF BREATH SINCE 2 DAYS
2. FEVER SINCE 1 DAY
3. ABDOMINAL PAIN SINCE 1 DAY
4. VOMITING 1 EPISODE
HOPI:
THE PATIENT WAS APPARENTLY ASYMPTOMATIC 4 YEARS AGO, THEN SHE HAD A FEVER WITH GENERALISED BODY WEAKNESS AND POLYURIA AND WAS DIAGNOSED HAVING TYPE 1 DM AND STARTED ON INSULIN.
2 YEARS AGO PATIENT HAD SIMILAR COMPLAINTS AFTER AN EPISODE PF FEVER AND WAS ADMITTED AT OUR HOSPITAL AND WAS TREATED HERE.
2 DAYS AGO SHE DEVELOPED SUDDEN ONSET SHORTNEESS OF BREATH SINCE 2 DAYS, GRADUALLY PROGRESSIVE AND PROGRESSED TO STAGE 4. SHORTNESS OF BREATH STARTED AFTER PATIENT MISSED TAKING 2 DOSES OF INSULIN. NO ORTHOPNEA, NO PND.
FEVER SINCE 1 DAY, HIGH GRADE ASOCIATED WITH CHILLS AND RIGORS, RELIEVED ON TAKING MEDICATION, NO DIURNAL VARIATION.
ABDOMINAL PAIN SINCE 1 DAY IN EPIGASTRIC REGION, LATER PROGRESSED TO DIFFUSE ABDOMINAL PAIN,
NO H/O VOMITING, LOOSE STOOLS, GIDDINESS.
HEADACHE PRESENT, VOMITING 1 EPISODE- NON BILIOUS, NON PROJECTIOLE, NOT BLOOD STAINED, CONTENT FOOD MATERIAL.
PAST HISTORY:
K/C/O TYPE 1 DM SINCE 4 YEARS, ON BIPHASIC INSULIN 30/70
H/O 2 PREVIOUS ADMISSIONS FOR FEVER IN LAST 4 YEARS
PERSONAL HISTORY ;
DIET : MIXED
APPETITE : NORMAL
SLEEP : NORMAL
BOWEL AND BLADDER : REGULAR
NO ALLERGIES
FAMILY HISTORY :
H/O DIABETES IN YOUNGER SISTER FROM 6 YEARS OF AGE
GENERAL EXAMINATION :
PATIENT IS CONSCIOUS , COHERENT , COOPERATIVE
MODERATELY BUILT AND NOURISHED .
NO SIGNS OF PALLOR , ICTERUS , CYANOSIS , CLUBBING ,LYMPHADENOPATHY, EDEMA.
VITALS :
TEMPERATURE: 99.1F
PR - 120BPM
BP - 110/70 MMHG
RR - 28CPM
SPO2 - 98% ON ROOM AIR
GRBS - 526 MG%
SYSTEMIC EXAMINATION :
PER ABDOMEN :
INSPECTION :
ABDOMEN IS SCAPHOID
UMBILICUS IS CENTRAL
ALL QUADRANTS ARE MOVING EQUALLY WITH RESPIRATION
NO SINUSES , ENGORGED VEINS, VISIBLE PULSATIONS .
HERNIAL ORIFICES ARE FREE.
PALPATION :
NO LOCAL RISE OF TEMPERATURE
NO TENDERNESS
LIVER AND SPLEEN - NOT PALPABLE
PERCUSSION : TYMPANIC NOTE HEARD OVER THE ABDOMEN.
FLUID THRILL ABSENT
SHIFTING DULLNESS ABSENT
AUSCULTATION :
BOWEL SOUNDS ARE HEARD.
CARDIOVASCULAR SYSTEM :
INSPECTION:
SHAPE OF CHEST IS ELLIPTICAL.
NO RAISED JVP
NO VISIBLE PULSATIONS, SCARS , SINUSES , ENGORGED VEINS.
PALPATION :
APEX BEAT - FELT AT LEFT 5TH INTERCOSTAL SPACE
NO THRILLS AND PARASTERNAL HEAVES
AUSCULTATION :
S1 AND S2 HEARD.
RESPIRATORY SYSTEM:
INSPECTION:
SHAPE- ELLIPTICAL
B/L SYMMETRICAL
BOTH SIDES MOVING EQUALLY WITH RESPIRATION .
NO SCARS, SINUSES, ENGORGED VEINS, PULSATIONS
PALPATION:
TRACHEA - CENTRAL
EXPANSION OF CHEST IS SYMMETRICAL.
VOCAL FREMITUS - NORMAL
PERCUSSION: RESONANT BILATERALLY
AUSCULTATION:
BILATERAL AIR ENTRY PRESENT
NORMAL VESICULAR BREATH SOUNDS HEARD
CENTRAL NERVOUS SYSTEM:
E4V5M6
SPEECH- NORMAL
NO SIGNS OF MENINGEAL IRRITATION.
CRANIAL NERVES- INTACT
SENSORY SYSTEM- NORMAL
MOTOR SYSTEM:
TONE- NORMAL
POWER- BILATERALLY 5/5
REFLEXES RIGHTLEFT
BICEPS ++ ++
TRICEPS.++. ++
SUPINATOR + +
KNEE. ++. ++
ANKLE +. +
BILATERAL PLANTAR FLEXOR
COURSE IN THE HOSPITAL:
A 14 YEAR OLD FEMALE PRESENTED WITH ABOVE MENTIONED COMPLAINTS .PATIENT WAS EVALUATED CLINICALLY AND APPROPRIATE INVESTIGATIONS WERE DONE. PATIENT WAS FOUND TO HAVE DIABETIC KETOACIDOSIS WITH HIGH ANION GAP. PATIENT WAS TREATED WITH IV FLUIDS AND INSULIN INFUSIONS. SERIAL ABGS WERE DONE WHICH SHOWED RESOLVED METABOLIC ACIDOSIS. PATIENT HAD FEVER SPIKES AND TREATED SYMPTOMATICALLY WITH ANTIPYRETICS. PATIENT RECOVERED SYMPTOMATICALLY AND DISCHARGED IN STABLE CONDITION .
Provisional Diagnosis
DIABETIC KETOACIDOSIS SECONDARY TO NON COMPLIANCE
K/C/O DM1 SINCE 4 YEARS
Investigation
17/04/23
HEMOGRAM
HB- 14.8 GM/DL
TLC- 18,000CELLS/CU.MM
N/L/E/M: 68/27/4/1
PLT-1.50 LAKHS/CU.MM
18/04/2023
HEMOGRAM:
HB- 12.3 GM/DL
TLC- 8600CELLS/CU.MM
N/L/E/M: 50/41/3/6
PLT-3.87 LAKHS/CU.MM
20/04/23
HEMOGRAM
HB:13.1 GM/DL
TLC: 6300 CELLS/CUMM
N/L/E/M:28/66/2/4
PLT: 3.29 LAKHS/CUMM
Treatment Given(Enter only Generic Name)
17/04/23
1. INJ 5 U IV/STAT
2. INJ HAI 1 ML +39ML @ 4ML/HOUR
3. IV FLUID- 3 UNITS NS @250 ML/HOUR
4. FLUSODEX(0.45%+5% DEXTROSE) AFTER GRBS <200 GM/DL
