30 year old male with DKA K/C/O Diabetes since 4 years Pulmonary TB 4 years ago

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30 year old male patient resident of suryapet and a watchmen by occupation came to casualty with 

Chief complaints:

Loose stools and vomitings since yesterday morning and shortness of breath since yesterday evening. 

History of presenting illness:

Patient was apparently asymptomatic till yesterday morning then he developed vomitings which are non bilious, non projectile, non blood tinged filled with food particles(10 episodes since yesterday which subsided from today morning). C/o loose stools 2 episodes yesterday morning which are watery, non blood tinged,non mucopurulent,not associated with fever, pain abdomen. C/o shortness of breath (grade 3) from yesterday evening which is not associated with chest pain, palpitations, orthopnea, pnd. 

Patient was admitted in Gandhi hospital yesterday evening and was given IV fluids 

And Inj.HAI 40iu. 

Patient then came to our hospital due to shortness of breath 

Past History:

He is a K/C/O DM since 4 years(was on insulin mixtard 10u-X-10u and was shifted to Tab.Metformin 500). He also has H/O Pulmonary TB 4 years ago (used ATT for 6 months)Tab. Glipizide 5 mg PO/BD from 1 week). H/O Pulmonary effusion(ICD was present for 10-15 days 

Not a K/C/O HTN CAD CVA ASTHMA EPILEPSY THYROID DISORDERS. 

 

Personal history:

Diet-mixed 

Appetite-normal 

Sleep-adequate 

Bowel and bladder movements-regular  

Addictions:90 ml whiskey thrice daily

Routine history:

Patient used to do centring work 4 years back then one day he had fever and increased urinary frequency and was lethargic so went to a local rmp and diagnosed to have diabetes, so he stopped doing centring work as he thought he might have injuries and may not heal. He didn't go to any work  for 5 to 6 months because of fatigue and cough and diagnosed with TB ( he used 6 months mediation and was complient). Now he is working as mechanic. 

Current daily routine:

He wakes up at 6 am and takes 10 U of HAI and has breakfast and goes to work and has lunch at 2pm and then goes around for a walking if he feels bloated and takes 10 U of HAI before having dinner at 8 pm and sleeps at 10pm.

 

                                      

General examination:

Patient is conscious, coherent and cooperative  He is moderately built and moderately nourished

No signs of icterus, cyanosis, clubbing, lymphadenopathy, edema

Vitals:

Patient is conscious, coherent, cooperative. 

Temp: 98.7F

PR- 106 bpm

RR-23cpm

BP-130/70 mm of Hg

Spo2 - 98%

GRBS:130mg/dl

Systemic examination:

PER ABDOMEN 

Inspection: 

No Abdominal distension 

No scars, sinuses, mass visible

Palpation:

Inspectory findings are confirmed 

No local rise of temperature

No Tenderness present 

Auscultation:

Normal bowel sounds heard

RESPIRATORY SYSTEM EXAMINATION

Inspection:

Bilaterally Symmetrical chest movements present 

No scars and sinuses 

Trachea central

Palpation:

Inspectory findings are confirmed

Percussion: 

Resonant note present in all lung areas

Auscultation:

Normal vesicular breath sounds heard. 

CARDIOVASCULAR SYSTEM EXAMINATION 

Inspection : 

Bilaterally symmetrical chest present 

No scars, sinuses

Palpation:

Inspectory findings are confirmed

Apex beat normal

On Auscultation : 

S1 S2 heard, no murmurs or additional heart sounds

CENTRAL NERVOUS SYSTEM EXAMINATION 

Higher mental functions intact 

Cranial nerves intact 

No focal neurological defecits

Provisional diagnosis

Diabetic ketoacidosis with K/C/O Diabetes since 4 years and Pulmonary TB 4 years ago

Investigations:

GRBS

15/7/2023

7pm 216mg/dl

8pm 180mg/dl

9pm 195mg/dl

10pm 209mg/dl

16/7/2023

12am 192mg/dl

1am 196mg/dl 

2am 168mg/dl

3am 157mg/dl

5am 153mg/dl

6am 132mg/dl

7am 130mg/dl

8am 112mg/dl

10am 116mg/dl

12pm 126mg/dl

2pm 128mg/dl

4pm 135mg/dl

6pm 142mg/dl

8pm 252mg/dl

10pm 295mg/dl

17/7/23

12am 185mg/dl

2am 194mg/dl

4am 220mg/dl

6am 179mg/dl

8am 170mg/dl

Treatment:

16/7/23

1.IV Fluids 0.4%NS IV @250 ml/hr

2.Inj.Hai 40u in 39 ml NS @ 2.5 ml/hr

3.Inj.5%Dextrose @100 ml/hr according to GRBS 

4.Monitor grbs hourly

5.Monitor vitals second hourly

6.strict I/O charting

17/7/23

1.Inj.nph s/c BD premeal according to GRBS 

2.Inj.Hai s/c TID premeal according to GRBS 

3.Grbs 7.profile monitoring 

4.Monitor vitals fourth hourly

5.strict I/O charting