36 year old male with vomitings and sob
A VISHAL
1701006001
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Our 36 yr old male came to casualty with the chief complaints of shortness of breath since yesterday morning.
Vomitings since yesterday
HOPI:-
Patient was Apparently asymptomatic 5 yrs back then he was diagnosed as diabetes was using OHA intially & then later after 2 yrs shifted to Inj.insulin .First admission was 15 days prior for which he admitted due to skippage of insulin & took symptomatic treatment & also has an hyperglycemic attack 1 yr back with similar complaints with cough ,cold,chestpain ,giddiness ,fever (high grade) not associated with chills ,vomiting ,loose stools .
Missing of insulin dosage .
Now came with SOB at rest , vomitings 2 episodes -food particles as content.
PAST HISTORY:-
Known case of DM since 7 yrs(on isophane insulin -25 units).
Not a known case of HTN,Asthma,CAD
EXAMINATION:-
Patient conscious,, coherent, cooperative.
No pallor ,Icterus, cyanosis, lymphadenopathy, clubbing.
Temp- 98.6f
PR- 72 BPM
RR-40 cpm
Bp-130/80 mmHg
GRBS-515 mg/dl
CVS-S1,S2 +
R/S-BAE+,NVBS
CNS-NAD
P/A - soft,non tender.
PROVISIONAL DIAGNOSIS:-
DKA secondary to missing insulin .
Investigations:-
TREATMENT:-
1).IVF.2unitsNS bolus over 1 hr.
2 units NS over nxt 1 hr
Ns@ 250 ml/hr for 6 hrs.
NS @ 150 ml/hr for 12 hrs.
2.)Inj.NAHCO3 50 mEq IV STAT followed by 100 mEq in 100 ml NS STAT given
3) INJ.HAI 6 units IV STAT (GRBS-515mg/dl)
GRBS - High=>INJ.4 units IV STAT
INJ.HAI (40U + 39 ml NS)@6ml/hr for 5 hrs ,3 ml /hr for nxt 5 hrs ,2 ml /hr for nxt 5 hrs.
4)Inj 5%Dextrose @100ml /hr(if GRBS <200mg/dl
5)Inj THIAMINE 1amp with 100ml NS IV/BD
6)Inj pan 40mg iv stat f/b OD
7)Inj zofer 4mg iv stat f/b tid
AMC Bed no 3
ADMITTED ON 01/09/2022
04/09/2022
S: Shortness of Breath subsided
O:
Patient is conscious,coherent and cooperative
BP - 110/80 mm Hg
PR - 84 bpm
RR- 18 cpm
Temp- Afebrile
spo2 - 99% on RA
CVS-S1,S2 +,no added sounds heard
R/S-BAE+,clear
P/A-soft , non tender
CNS-NAD
GRBS - 192 mg/dl @ 8.00 am
I/O CHARTING - 2300 / 1100 ml
A : Diabetic Ketoacidosis secondary to Missed Insulin
History of Recurrent DKA
P :
1. INJ. HUMAN ACTRAPID INSULIN /SC/TID
10 units - 8 units - 10 units
2. INJ. NPH /SC/BD
8 UNITS - 8 UNITS
3. TAB. PANTOP 40 mg IV /OD
4. INJ. THIAMINE PO/OD
5. GRBS MONITORING 7 UNITS PROFILE
6. MONITOR VITALS AND INFORM SOS
7. SYP. POTKLOR 10 ML IN 1 GM OF WATER /PO/TID
