A 19 yr old male with c/o of vomitings & SOB

 Past admission 

18 year old male patient elog

June 12, 2021

 A 18 year old male,from miryalaguda,who is a student, came to the hospital with chief complaints of low backache 1 week ago,fever since 5 days ,yellowish discolouration of eyes since 3 days ,vomitings (2 episodes) and loose stools(3 episodes)and blood tinged urine yesterday morning

HISTORY OF PRESENT ILLNESS-

Patient was apparently asymptomatic 6 months ago,then he noticed gradual loss of weight since 6months,patient had history of polyuria,nocturia,polydypsia since 2 months

10 days ago, patient attended a function outside and after 2 days he developed low backache and 2 episodes of vomitings and 3 episodes of loose stools for one day which subsided on its own.

Next day,patient developed fever,intermittent,high grade,subsided with medication. Patient went to RMP and got treated for fever.patient noticed yellowish discolouration of eyes and urine 3 days ago.Nausea and loss of appetite +

Burning micturition is present


PAST HISTORY-

No history of diabetes,asthma,TB ,epilepsy

PERSONAL HISTORY-

Diet-mixed

Appetite-lost

Bowel and bladder-regular

Sleep-adequate

FAMILY HISTORY-

No relevant family history

GENERAL EXAMINATION-

Patient is conscious,coherent and cooperative

VITALS-

Temp-



BP-110/70 mm Hg

PR-94

RR-24

 Pallor- absent

Icterus-present




Cyanosis-absent

Lymphadenopathy-absent

Clubbing-absent

Oedema-absent

SYSTEMIC EXAMINATION

CVS-

S1,S2 heard

No murmurs 

No thrills

RESPIRATORY-

Bilateral air entry with normal vesicular breath sounds,no wheeze,no dyspnea ,position of trachea is central

ABDOMEN-

Shape-scaphoid

Tenderness in right hypochondrium,epigastrium

No palpable mass, free fluid,no bruit

Liver and spleen- not palpable

Bowel sounds-present

PROVISIONAL DIAGNOSIS-

acute viral hepatitis

Denovo DM type 1

DKA





March 24/3/22

Current admission :

Unit 4

New admission 

Amc bed 6 : 

19 yrs old male patient came to the casuality with c/o vomitings since 1 day,  c/o SOB  since yesterday afternoon. 

Patient was apparently asymptomatic 2 days back then he developed nausea & vomitings,  10 episodes since day before yesterday afternoon,  food as content,  non projectile,  non bilious. 

No c/o fever,  loose stools,  pain abdomen  , cough,  cold,  burning micturition. 

Patient is a known case of type 1 Diabetes mellitus , using insulin 

HAI 26---- 26----- 35

NPH 26-----x-------35

Patient didn't miss his insulin,  patient is using insulin regularly 

Patient got admitted in October 2021 with DKA was discharged on 

HAI 26---- 26----- 35

NPH 26-----x-------35

In June 2021 there is a h/o  Acute fulminant hepatic failure ( infections / toxin mediated)  , hepatic encephalopathy,  coagulopathy,  ? Cerebral malaria,  ? MISC,  DKA ( denovo detected DM)  , metabolic seizures ( absence seizures)    

O/E : 

Pt is c/c/c 

Vitals : 

Temp: 99.8 f

HR: 78 bpm

RR : 20cpm

BP : 130/90 mm hg

Spo2: 99 @ RA

GRBS :

At admission : 361 mg/dl --6U IV / stat given 

2 am 318 HAI @ 5 ml / hr

3am  328 HAI @ 5ml / hr

4am 272 HAI @ 5ml / hr

5am  216 HAI @ 5 ml / hr

6am 170 HAI @ 5 ml / hr

7am 154 HAI @ 5 ml / hr

8am 140 HAI @ 5 ml / hr --- started  D5 @ 100 ml / hr



SYSTEMIC EXAMINATION : 


CVS : S1 S2  + . 

RS : BAE + NVBS + 

PA: mild tenderness in epigastric region 

CNS :  NAD 

 

Diagnosis : Diabetic ketoacidosis secondary to ?  acute gastroenteritis 


TREATMENT :

NS 3 Litres bolus given 

IVF - NS,  RL @ 200 ml / hr

Inj. HUMAN ACTRAPID 6U IV / stat given (361---> 297)

Inj. HUMAN ACTRAPID 40U in 39ml NS @ 5 ml /hr 

Nill by mouth 

Inj.  PANTOP 40 mg IV / OD 

Inj. Zofer 4mg IV /TID 

INJ. NEOMOL 1 gm IV /SOS ( if temp > 101 F)  

Tab.  DOLO 650 mg PO/ TID 



Urine for ketone bodies : positive 

ABG : 

pH : 7.10

 pCO2 : 6.0

HCO3 : 1.8 

S HCO3 : 6.5 

SO2 : 96.0


UNIT 4 

Day 3 of admission 

ICU BED 6 

S: 

C/o vomitings subsided  , c/o SOB subsided 

O: 

Pt is c/c/c 

Vitals : 

Temp: 99.4 f

HR: 78 bpm

RR : 20cpm

BP : 130/90 mm hg

Spo2: 99 @ RA

GRBS :

25/3/22

10 am - 119  HAI @ 5 ml / hr

11am - 190 HAI @ 5 ml/ hr

12 pm - 239  HAI @ 5 ml/ hr

1pm-166.    HAI @ 5 ml/hr

2pm - 143. HAI @ 5 ml / hr

5pm - 74.   HAI @ 5ml / hr ( D5 @ 100 ml / hr)  

6 pm - 258 HAI @ 5ml/ hr 

8pm - 202  HAI @ 5 ml / hr

10 pm - 229 HAI @ 5 ml/ hr

26/3/22

12 am - 190 HAI @ 5 ml/ hr

4 am - 180 HAI @ 5 ml/hr

6 am -264 HAI @ 5 ml/ hr

8 am 291  HAI @ 5 ml / hr

10am - 256 HAI @ 5 ml/ hr


A : Diabetic ketoacidosis with k/c/o type 1 DM, ?  MISC post COVID ( July 2021) 


P: 

IVF - NS,  RL @ 100ml / hr

Inj. HUMAN ACTRAPID 40U in 39ml NS @ 5 ml /hr 

Nill by mouth 

Inj.  PANTOP 40 mg IV / OD 

Inj. Zofer 4mg IV /TID 

INJ. NEOMOL 1 gm IV /SOS ( if temp > 101 F)  

Tab.  DOLO 650 mg PO/ TID

Inj. 5% dextrose 50 ml / hr ( if grbs< 250) 


Investigations : 

ABG : 

25/03/22.              26 / 03/22

pH : 7.10.              pH : 7.3 

 pCO2 : 6.0.          pCO2 : 26.8 

HCO3 : 1.8.           HCO3 : 13.9 

S HCO3 : 6.5.       S HCO3 : 16.7

SO2 : 96.0.            SO2 : 96. 0 


https://nikithaedam48.blogspot.com/2021/06/18-year-old-malefrom-miryalagudawho-is.html?m=1


UNIT 4 

Day 5 of admission 

ICU BED 6 

S: 

C/o vomitings subsided  , c/o SOB subsided 

O: 

Pt is c/c/c 

Vitals : 

Temp: 99.4 f

HR: 78 bpm

RR : 20cpm

BP : 120/80 mm hg

Spo2: 99 @ RA



GRBS :

27/03/22

10 am - 263--- 26U NPH + 26 HAI 

12 pm - 156

1pm-69 --- 10 U HAI

3pm - 177

8pm - 249 ---10 U NPH + 10 HAI 

10 pm - 141

20/03/22

8 am - 365 ---15 NPH + 10 U HAI



A : Diabetic ketoacidosis secondary to ? Inadequate insulin,  ? Acute GE 

K/C/O type 1 DM 

H/O acute fulminant hepatitis failure, ? MISC post COVID ( JULY 2021 ) 


P: 

IVF - NS,  RL @ 100ml / hr

Inj. HUMAN ACTRAPID 20 U 

inj. NPH 15 U 

GRBS according to 7 point profile 

Before & 2hrs after breakfast 

Before & 2 hrs after lunch 

Before & 2 hrs after dinner 

Inj.  PANTOP 40 mg IV / OD 

Inj. Zofer 4mg IV /TID 

INJ. NEOMOL 1 gm IV /SOS ( if temp > 101 F)  

Tab.  DOLO 650 mg PO/ TID

Strict I/O charting 

BP,  PR  monitoring 

https://nikithaedam48.blogspot.com/2021/06/18-year-old-malefrom-miryalagudawho-is.html?m=1

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