40 yr old male with Acute Pancreatitis with uncontrolled sugars ? diabetic nephropathy
March 4th , 2022
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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 :
2-D ECHO (4/3/22)
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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