Case 2

 August 23, 2021

Date of Admission- 22-8-21


A 56 year old female presented to OPD with chief complaints of abdominal pain and vomitings.


HISTORY OF PRESENT ILLNESS 


Patient was apparently alright yesterday till 7pm then She had sudden onset of vomitings associated with abdominal pain.

After an hour she had another episode

Till 1am she had 4 episodes of vomitings

No history of chest pain, fever, pedal edema, blurring of vision, loose stool


HISTORY OF PAST ILLNESS 


Diabetic since 5 year

2 yeara on inj mixtard

No history of hypertension, asthma, tuberculosis, epilepsy 


PERSONAL HISTORY 

Diet- mixed

Appetite- normal

Bowel movement- normal

Sleep adequate 

No addictions 

 Menopause attained 20 years back.


FAMILY HISTORY 

No history of DM, asthma, thyroid in the family.


GENRAL EXAMINATION 

Patient is conscious, coherent, co-operative.


There is no sign of pallor, cynosis, cyanosis, pedal edema


VITALS

Temperature- afibrile

Pulse rate- 90 bpm

Respiratory rate- normal

BP- 140/80 

Spo2-98%


SYSTEMIC EXAMINATION 


Cardiovascular System 

Thrills- No

Cardiac sound- S1, S2


Respiratory system 

Breathe sounds- vesicular

Adventitious sounds- No



Central Nervous System 

Patient is conscious 

Speech- normal

No sign of meningitis irritation 

Motor and sensory system- normal



PROVISIONAL DIAGNOSIS

Diabetic Ketoacidosis


INVESTIGATION 


Haemogram- 22-08-21


Hemoglobin-13

Total count-17,000

Neutrophils-82

Lymphocytes-13

Eosinophils-01

Monocytes-04

Basophils-00

PCV-37.3

MCV-81.4

MCH-28.4

MCHC-34.9

RDW-CV-12.6

RDW-SD-38.3

RBC COUNT-4.58

PLATELET COUNT-2.71

SMEAR

RBC- Normocytic normochromic

WBC-Mild leucocytosis

PLATELETS- adequate 

HAEMOPARASITES-No haemoparasites

IMPRESSION-Normocytic normochromic with neutrophilic leucocytosis



Haemogram- 23-08-21


Hemoglobin-12.2

Total count-11,500

Neutrophils-65

Lymphocytes-30

Eosinophils-02

Monocytes-03

Basophils-00

PCV-35

MCV-82

MCH-28.6

MCHC-34.9

RDW-CV-13

RDW-SD-39.8

RBC COUNT-4.27

PLATELET COUNT-2.27


SMEAR

RBC- Normocytic normochromic

WBC-Mild leucocytosis

PLATELETS- adequate 

HAEMOPARASITES-No haemoparasites

IMPRESSION-Normocytic normochromic with mild leucocytosis

23-8-21






TREATMENT 

Inj HAI 1ml 40 units
39ml of NS
2ml per hour

5% dextrose infusion 
75ml per hour till acidosis resolves

GRBS 1 hourly

Inj Pantop 40mg IV OD





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