40 yr old male with Acute Pancreatitis with uncontrolled sugars ? diabetic nephropathy

 

March 4th , 2022 


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 a series of inputs available global online community of experts with the aim to solve the patient’s clinical problems with the collective current best evidence based inputs. This E log reflects my patient centred online learning portfolio and your valuable inputs in the comments section.

40year old male  who works as a field assistant who is chronic alcoholic came to casualty with complaints of abdominal pain since one day & vomitings (10-15 episodes)  since one day 


 Patient was apparently asymptomatic 1 day back  , since 3 days there h/o binge alcohol consumption (360ml whisky)   after which since 1 day he developed pain abdomen which was squeezing type predominantly in epigastric region diffuse type associated with nausea & vomiting 10 to 15 episodes/day.  Whenever he consumes water or food  he has vomitings -  nonbilious,  non projectile,  water or food as content. 

No h/o loose stools or constipation 

No h/o fever ,shortness of breath,  cough

H/o pancreatitis 3 years ago 

He is a k/c/o diabetes mellitus since 15 yrs,  since 1 yr using HAI 10U in the morning & 5U in the night , before which he was on oral hypoglycemic agents 

He is a k/c/o hypertension since 10 yrs using T. AMLODIPINE 5mg OD 


O/E : 

Pt is c/c/c 

Vitals : 

Temp: 98.4 f

HR: 100 bpm

RR : 18cpm

BP : 160/80 mm hg

Spo2: 99 @ RA

GRBS :  397 mg/dl 


SYSTEMIC EXAMINATION : 


CVS : S1 S2  + . 

RS : BAE + NVBS + 

PA: diffuse tenderness present,  more in left hypochondriac region, epigastric region & left iliac fossa

CNS :  NAD 






DIAGNOSIS : Acute Pancreatitis with  uncontrolled sugars ? diabetic nephropathy

 

TREATMENT : 

IVF : NS , RL @ 100ml/hr 

INJ. ZOFER 4mg IV /BD

INJ.PANTOP 40mg IV/OD

INJ. TRAMADOL 1amp in 100ml NS IV/BD

INJ. PIPTAZ 2.25gm IV /QID 

TAB. AMLONG 10mg PO/OD

GRBS monitoring 

INJ. HUMAN ACTRAPID according to sugars 

Inform SOS

INVESTIGATIONS :

Serum lipase :110IU/L
urine for ketones : negative 

2-D ECHO (4/3/22)




Ultrasound abdomen &pelvis (3/3/22):





Chest X-RAY  PA view (3/3/22):



Ecg on 3/3/22



Unit 4 

Day 3 of admission (5/2/22)

AMC BED 3 

S: Pain abdomen decreased 

O:

O/E

Pt is c/c/c 

Vitals : 

Temp: 98.4 f

HR: 94bpm

RR : 18cpm

BP : 160/80 mm hg

Spo2: 99 @ RA

GRBS :  

2pm (4/2/22)- 232 - 4 U insulin given 

8pm (4/2/22)- 212- 4U insulin given 

8am ( 5/2/22)- 230 - 4U insulin given 

I/O : 2900/2500



SYSTEMIC EXAMINATION : 


CVS : S1 S2  + . 

RS : BAE + NVBS + 

PA: soft, tenderness present in epigastrium & left hypochondrium 

CNS :  NAD 

A: Acute Pancreatitis with  ? diabetic nephropathy

 

P: 

IVF : NS , RL @ 100ml/hr 

INJ. ZOFER 4mg IV /BD

INJ.PANTOP 40mg IV/OD

INJ. TRAMADOL 1amp in 100ml NS IV/BD

INJ. PIPTAZ 2.25gm IV /QID 

TAB. AMLONG 10mg PO/OD

GRBS monitoring 

INJ. HUMAN ACTRAPID according to sugars 

Inform SOS 



Unit 4 

Day 4 of admission 

AMC BED 2 

S: Pain abdomen decreased 

O:

O/E

Pt is c/c/c 

Vitals : 

Temp: 98.4 f 

HR: 100bpm

RR : 20 cpm

BP : 150/90 mm hg

Spo2: 99 @ RA

GRBS :  

2pm (5/3/22)- 133 - 4 U insulin given 

8pm (5/3/22)- 150- 4U insulin given 

2am (6/3/22)- 120-  4U insulin given 

8am ( 6/3/22)- 132 - 4U insulin given



SYSTEMIC EXAMINATION : 


CVS : S1 S2  + . 

RS : BAE + NVBS + 

PA: soft, non tender 

CNS :  NAD 


A: Acute Pancreatitis with  ? AKI ( resolved ) 

With k/c/o HTN , DM 

 

P: 

Started on soft diet 

IVF : NS , RL @ 100ml/hr 

INJ. ZOFER 4mg IV /sos 

INJ.PANTOP 40mg IV/OD

INJ. TRAMADOL 1amp in 100ml NS IV/ sos 

TAB. AMLONG 10mg PO/OD

GRBS monitoring 

INJ. HUMAN ACTRAPID according to sugars 

Inform SOS 

INJ. OPTINEURON 1 amp in 100 ml NS i.v. OD 

INJ. THIAMINE 100mg in 100 ml NS i.v BD 



Unit 4 

Day 5 of admission 

Ward case

S: Pain abdomen decreased 

O:

O/E

Pt is c/c/c 

Vitals : 

Temp: 98.4 f 

HR: 100bpm

RR : 20 cpm

BP : 120/80 mm hg

Spo2: 99 @ RA

GRBS :  

2pm (6/3/22)- 186 - 4 U insulin given 

8pm (6/3/22)- 107 

2am (7/3/22)- 130

8am ( 7/3/22)- 123 - 4U insulin given





SYSTEMIC EXAMINATION : 


CVS : S1 S2  + . 

RS : BAE + NVBS + 

PA: soft, non tender 

CNS :  NAD 


A: Acute Pancreatitis with  ? AKI ( resolved ) 

With k/c/o HTN , DM 

 

P: 

Started on soft diet 

IVF : NS , RL @ 100ml/hr 

INJ. ZOFER 4mg IV /sos 

INJ.PANTOP 40mg IV/OD

INJ. TRAMADOL 1amp in 100ml NS IV/ sos 

TAB. AMLONG 10mg PO/OD

GRBS monitoring 

INJ. HUMAN ACTRAPID according to sugars 

Inform SOS 

INJ. OPTINEURON 1 amp in 100 ml NS i.v. OD 

INJ. THIAMINE 100mg in 100 ml NS i.v BD 






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