52 year old female patient with high blood sugars and vomitings
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PREVIOUS ADMISSION
DATE: 19/3/2022
DATE OF DISCHARGE : 23/3/2022
52 year old female who is a farmer came to the casuality with complaints of
Shortness of breath since afternoon
Vomitings since afternoon
Pain abdomen since afternoon
Dyspepsia since afternoon
HISTORY OF PRESENT ILLNESS :
Patient was apparently asymptomatic shortness of breath since afternoon( grade 2 to grade 3 ) according to NYHA classification
C/o vomitings ( 3 episodes food particle as content) , non bilious, non projectile
C/o pain abdomen ( diffuse type) associated with loose stools ( 2 episodes ) non blood typed , non foul smelling
C/o dyspepsia since afternoon
PAST HISTORY :
Similar complaints in the past ( was admitted in our hospital and treated 9 months back )
K/c/o DM since 4 years on insulin (HAI -17 U -x-10U)
N/ k / c /o HTN , Asthma , epilepsy , TB
O/E :
Patient is consious , coherent and cooperative
Bp:120/60mm hg
PR ; 112 bpm regular
RR :30 / min
Cvs : s1 s2 +
Rs : BAE +
P/A: soft , non tender
PROVISIONAL DIAGNOSIS:
Diabetic ketoacidosis secondary to GE
Investigations :
19/3/22
Urine for ketone bodies positive
10pm 1 am 5 am
PH 6.94. 7.25 7.35
PCO2 9.2 19.9 27.8
PO2 125 87 72.9
HCO3 1.9 8.6 15
St HCO3 5.2 12.3 17.4
20/3/22 21/3/22
PH 7.36 7.36
PCO2 27.5 31.0
PO2 80.6 79.5
HCO3 15.2 17.2
St HCO3 17.5 19.2
21/03/22
TREATMENT:
I. Inj HAI 6 U / IV /stat to Inj.HAI 40 IU in 39ml NS/IV/once 6 ml/hr
2.IVF - ns and rl @ 125 ml/ hr
3.inj pantop 40mg /IV /OD
4.inj zofer 4mg/iv/OD
ADVICE ON DISCHARGE:
1. INJ. HAI 10U—10U—10U
2. INJ.NPH 8U—8U
3. TAB. MVT PO/OD X 7 DAYS
The above information has been taken from the following blog
https://warshasukeerthirollno64.blogspot.com/2022/03/52-year-old-female-with-diabetic.html
SECOND ADMISSION
Patient came to the medicine OPD with complaints of
- 2 episodes of vomitings since morning
- Abdominal discomfort and excess thirst since morning
HISTORY OF PRESENT ILLNESS
Patient was apparently asymptomatic until morning, later which she developed vomitings which were sudden in onset, non bilious and non projectile. Content: food particles
Later she had vomitings of water followed by excess thirst and abdominal discomfort
No complaints of fever, cough and cold
PAST HISTORY:
K/C/O DM on Inj. HAI 10U TID
INJ. NPH 8U BD
till day before yesterday
( K/C/O DM since 5 years )
Yesterday she took only 15U of HAI in the morning and skipped NPH dosage, following which she developed vomitings since morning
N/K/C/O HTN, ASTHMA , TB, CAD
VITALS:
Temperature: 98.4F
PR: 126/min
RR: 32 CPM
BP: 110/80mmhg
SPO2: 98% on RA
GRBS: 700 mg% @ 4:00pm
GENERAL EXAMINATION
Patient is conscious/coherent/ cooperative
Oriented to time/ place / person
No pallor/cyanosis/icterus/ edema/ lymphadenopathy
CVS: S1S2 +, no murmurs
RS: BAE + , dyspnoea +
P/A: soft, non tender, BS+
CNS: NAD
INVESTIGATIONS:
Urine for ketone bodies: POSITIVE
Blood urea : 34 mg/dl
Serum creatinine: 0.8 mg/dl
TREATMENT GIVEN:
- IVF NS 100ml/hour
- Inj. HAI 5U/IV/ stat
- Inj. HAI 40units in 39ml NS IV @ 5ml/hour
- Inj. PIPTAZ 4.5 GM/iv/ stat TID
- Inj. OPTINEURON 1 amp in 100 ml NS/IV/OD
- Inj. PAN 40mg IV/OD
- Inj. ZOFER 4mg/IV/TID
- NBM TILL FURTHER ORDERS
- Strict I/O monitoring
- Hourly GRBS monitoring
08-05-2022
HOURLY GRBS MONITORING
7PM 548
8PM 330
9PM 149
10PM 123 (10D)
11PM 148
12AM 218
1AM 84
2AM 97
3AM 90
4AM 99
5AM 96
6AM 117
7AM 112
8AM 139
INSULIN DOSE OVER NIGHT:
5ML/HOUR
12 AM ABG AND SERUM ELECTROLYTES
URINE FOR KETONE BODIES AT 6:20 PM (8/05/2022)
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