52 year old female with diabetic ketoacidosis secondary to gatroenteritis

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M kalpana
9th semester

CASE —

52 year old female who is a farmer came to the hospital on 19/3/22 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 till 18/3/22 then she developed 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 

Personal history—

Appetite - normal

Diet - mixed

Bowel &bladder- loose stools -2episodes 

Sleep -adequate

No known addictions & allergies

General examination —

Patient is consious , coherent and cooperative moderately built and moderately nourished 

Pallor present

No icterus , clubbing , cyanosis , lymphadenopathy , edema

Vitals-

Temperature: afebrile

Bp:120/60mm hg 

PR ; 112 beats per min

RR :30 cycles / min

Systemic examination -

Respirtory system:

Bilateral air entry present

Normal vesicular breath sounds heard

Abdominal examination -

No tenderness and local rise of temperature

Soft and no organomegaly

Cvs examination-

S1 S2 heard

No mumurs heard

Cns examination -

Intact and no abnormal findings 

Investigations-

On 19/03/22

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

                     

      

                    20/03.        21/03

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

On 21/3/22






Diagnosis—

Diabetic ketoacidosis secondary to gastroenteritis

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