A 52 yr old female with diabetic ketoacidosis secondary to GE

 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centred online learning portfolio and your valuable inputs on the comment box


 52 year old female who is a farmer came to the casuality with complaints of shortness of breath 2days back, vomitings, pain abdomen 2days back.Dyspepsia since 2days.

HISTORY OF PRESENT ILLNESS :

Patient was apparently asymptomatic 2days back.Then she developed shortness of breath  ( grade 2 to grade 3 ) according to NYHA classification .

She also had C/o vomitings ( 3 episodes food particle as content) , non bilious, non projectile. 

 Also C/o pain abdomen ( diffuse type) associated with loose stools  ( 2 episodes ) non blood typed , non foul smelling. 

And C/o dyspepsia since 2days.


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)

Not/ k / c /o  HTN , Asthma , epilepsy , TB .

PERSONAL HISTORY:

Pt takes mixed diet, her appetite is normal, sleep-adequate, bowel and bladder movements are regular and no addictions.

FAMILY HISTORY:

No relevant family history.

PHYSICAL EXAMINATION:

GENERAL EXAMINATION:

Patient is conscious coherent and cooperative.Moderately built and nourished.

Pallor is present.

No icterus , cyanosis, clubbing, lymphadenopathy, pedal edema.









  

Vitals:

Temp: 98.5F

Bp:120/60mm hg 

PR ; 112 bpm  regular

RR :30 cycles / min


 Systemic examination:

Cvs : s1 s2 +, no murmurs.

Rs: dyspnea present ( on admission), BAE+

CNS: No focal neurological deficit.

P/A: soft , non tender

PROVISIONAL DIAGNOSIS:

Diabetic ketoacidosis secondary to GE.

INVESTIGATIONS:

19/3/22

Urine for ketone bodies positive.

                10pm   1am  5am

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
























21/3/22






 TREATMENT:

1. Inj HAI 6 IU/ IV /stat to Inj HAI 40 IU in 39ml NS / IV/ once 6ml/hour.
2.IVF - NS and RL @125ml/hr
3.inj pantop 40mg/iv/od
4.inj zofer 4mg/ iv/od
5.inj piptaz 2.25mg/iv/bd.


































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