20M DKA with DM TYPE -1

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 series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment.



A 20yr old Male , driver by occupation R/o Nalgonda came to the OPD on 18th Aug 2023 with c/o fever since 2 days and vomiting since 6 hours.



HISTORY OF PRESENT ILLNESS:

Patient was apparently asymptomatic 2 days back and then he developed fever which is low grade not associated with chills and rigors , relieved with medication. 

No diurnal variation.

H/o 3 episodes of Vomiting since 6 hours. contains food material, blood tinged, non bilious, non projectile.

Skipped one dose insulin last evening.

No H/O loose stools, pain abdomen, giddiness.

No H/O cough, burning micturition.



HISTORY OF PAST ILLNESS:

K/C/O DM type I since 2 yrs.

HAI 140----140----140

NPH 260---x---260

N/K/C/O HTN, TB, Asthma, CAD, CVD, Thyroid, Epilepsy disorders



TREATMENT HISTORY:

DM TYPE I medication since 2 yrs



SURGICAL HISTORY: NO



FAMILY HISTORY:

N/K/C/O DM, HTN, TB, Asthma, Thyroid, CAD, CVD, Stroke, Cancers, Hereditary diseases, sibling histories



PERSONAL HISTORY:

Unmarried

Driver by occupation

Diet: mixed

Appetite: normal

sleep: adequate

Bowel and bladder : regular

Addictions: no

Allergies: no known



GENERAL EXAMINATION:

Ht: Wt:    

Patient is conscious, coherent and cooperative to time, place and person.

No pallor

No icterus

No clubbing

No cyanosis

No koilonychia

No lymphadenopathy

No edema



Vitals: Temp:96.8F

BP: 130/70mmHg

PR:104 bpm

RR: 22 cpm

GRBS: 311mg%

SpO2: 98%



SYSTEMIC EXAMINATION:



CVS: SI S2 heard

no thrills

no murmurs

RS: Dyspnoea present

no wheeze

central position of trachea

normal vesicular breath sounds +

ABDOMEN: Shape: scaphoid

no tenderness

normal hernial orifices

no free fluid

no bruits

liver and spleen not palpable

bowel sounds not heard

CNS: conscious

normal speech

no neck stiffness

kernig's sign negative

cranial nerves, motor system , sensory system: intact, normal

Glasgow scale: E4V5M6

Cerebellar signs- no

finger nose in coordination: yes

Knee heel in coordination: yes

GAIT: normal

MUSCULOSKELETAL SYSTEM: normal



PROVISIONAL DIAGNOSIS:

DIABETIC KETOACIDOSIS with TYPE I DM



PHYSICAL EXAMINATION:







INVESTIGATIONS 

 18th Aug 2023

ABG


ECG:

19th aug 2023
APTT

BT & CT

HEMOGRAM: 
decreased Hb, low PCV

URINE FOR KETONE BODIES:: +ve

RPR:

RANDOM BLOOD SUGAR: high 409

LFT: increased AKP

RFT:

FASTING BLOOD SUGAR:

PT:

S. ELECTROLYTES


MANAGEMENT:

DAY 1 : (18-8)
NBM till further order
IVF - NS @ 150ml/hr
INJ. HAI 40 IU in 39ml NS @2ml/ hr 
INJ ZOFER 4mg 
INJ NEOMOL 1gm 
Strict I/O Charting
Monitor vitals and inform SOS

DAY II:(19-8)
NBM till further order
IVF - NS @100ml/hr
INJ HAI 40 IUIN 39ml NS @2ml/hr
INJ ZOFER 4mg
IVF 5D @50ml/hr
INJ NEOMOL 1gm IV/ SOS 
Strict I/O Charting
Monitor vitals & inform SOS
INJ K+ 2amp in 250ml NS/ slow in 2 hrs (if S.K+ < 5mEq/l)




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