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


5.INJ NEOMOL 500 MG IV/SOS IF TEMP >101F
6. TAB PCM 500 MG PO/TID
7.TAB ZOFER 4 MG PO/SOS

18/04/23
1. NBM TILL FURTHER ORDERS
2. INJ HAI 1 ML IN 39 ML NS @2ML/HOUR
3. IV FLUIDS 0.45% NS +5%DEXTROSE @125 ML/HOUR
4. TAB PCM 500 MG PO/SOS

19/04/23
1. IV FLUIDS 0.45% NS @ 125 ML/HOUR
2. INJ HAI S/C TID
NPH S/C BD

20/04/23
1. IV FLUIDS 0.45% NS @ 100 ML/HOUR
2. INJ HAI S/C TID
NPH S/C BD
3. INJ KCL 1 AMP IN 1 UNIT 0.45 NS @100 ML/HOUR
4. SYP POTKLOR 10 ML IN GLASS OF WATER PO/TID
5. PLENTY OF ORAL FLUIDS

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