27 yr old male with sob and vomitings
A VISHAL
1701006001
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27 yr old male patient came to the opd with chief complaints of
SOB since yesterday afternoon.
Vomitings since 1 day.
HOPI:-
Patient was apparently asymptomatic 2 days back. He has history of binge alcohol drinking 1 day back. There is no intake of food since 2-3 days as he is taking the alcohol.
Vomitings-2 episodes watery in consistency since 1 day.
Then he developed SOB since yesterday afternoon.
No c/o fever, cough, pedal edema, orthopnea, PND.
PAST HISTORY:-
Not a K/C/O HTN, DM, CAD, CVA.
EXAMINATION:-
Patient was conscious, coherent, cooperative.
No pallor, icterus, cyanosis, clubbing, lymphadenopathy.
Temp-97. 5f
PR-120 bpm
RR-28 cpm
BP-120/80 mmhg
Cvs - s1 s2+
R/S- BAE+
CNS- NAD
P/A - soft, nontender.
PROVISIONAL DIAGNOSIS:-
STARVATION KETOACIDOSIS
Investigations:-
TREATMENT:-
1) INJ. 25D stat IV.
2) INJ. NS 500 ml + 1 amp thaimine IV STAT given bolus.
3) 2 × DNS @ 100 ml /hr, 2 ×NS @100 ml/hr.
4) INJ. PAN 40 mg IV OD.
5) INJ. ZOFER 4 mg IV /TID.
6) INJ. THIAMINE 100 mg 1amp in 100 ml NS/IV/TID.
16/9/22 at 8:00 am
Day 1:-
S: no fresh complaints
O: on examination
Patient is conscious, coherent, cooperative.
Temp-99.5f
PR-80 bpm
RR-22 cpm
BP-120/70 mmhg
Grbs: 313 mg/dl
Cvs - s1 s2+
R/S- BAE+
CNS- NAD
P/A - soft, nontender.
A: starvation ketoacidosis
Hypoglycemia secondary to alcohol
P: plan of treatment
1) normal diet and plenty of oral fluids
2) 1 × DNS @ 50 ml /hr, 2 ×NS @50 ml/hr.
3) INJ. PAN 40 mg IV OD.
4) INJ. ZOFER 4 mg IV /TID.
5) INJ. THIAMINE 100 mg 1amp in 100 ml NS/IV/TID.
6)4th hourly grbs and vitals monitoring
