48 year old with hyperglycaemia

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Name: Sri Chandana 

Roll no: 98

GENERAL MEDICINE

48 year old male Patient lorry driver by occupation came to general medicine department with c/o 

Dragging type of pain in both upper and lower limbs since 1 week

Generalized weakness since 4 days

Fever since 1 day

HOPI

patient was apparently asymptomatic 1week back then had dragging type of pain in upper and lower limbs since 1 week which is continuous,aggravated on working with no relieving factors associated with generalized weakness

C/o fever since 1 day intermittent in onset,high grade,not associated with chills and rigors,more during night,no aggravating factors and relieved on medication.

No c/o cough,cold,sore throat

No c/o headache

No c/o burning micturition 

Past History

K/c/o DM type II since 5 years 

N/K/c/o hypertension,CAD,TB,asthma,epilepsy 

No similar complaints in the past

Personal History

Mixed diet

Normal Appetite

Regular bowel and bladder movements

Sleep - adequate

Addictions

H/o Alcohol intake for 20 years,stopped 5years back

H/o smoking beedis for 20 years,stopped 5 years back

Treatment History 

Drug History

Tab.voglibose 0.2mg 

Tab.Gliclazide 40mg 

Tab.Metformin 500mg PO/OD for diabetes since 5 years

Family History

No significant family history

GENERAL EXAMINATION

patient is conscious,coherent and cooperative 

Moderately built and malnourished 

Pallor present

No signs of icterus,cyanosis,clubbing,edema of feet and lymphadenopathy 

VITALS

temperature - 100.8F

Pulse rate - 80bpm

BP - 100/ 60 mmHg

RR  - 18 cpm

GRBS - 393 mg/dl

SYSTEMIC EXAMINATION 

CARDIOVASCULAR SYSTEM 

S1,S2 heard,no murmurs,no thrills

RESPIRATORY SYSTEM 

position of trachea - central

Normal vesicular breath  sounds 

No dyspnea and wheeze

PER ABDOMEN

Shape of abdomen - scaphoid

Umbilicus is central in position

No Tenderness on Palpation

Temperature - High

Liver is non palpable 

Spleen is non palpable 

Bowel sounds heard

CNS - NFND

INVESTIGATIONS 

2d echo

ECG

Fever chart s

vitals

25/10/23

RBS - 461mg/dl

Blood urea - 32mg/dl

Albumin - nil

Pus cells - 2-3

Epithelial cells - 1-2

Serum creatinine - 0.9

Na - 136mEq/L

K - 3.9 mEq/L

Cl - 101mEq/L

Ca- 1.04mg/dl

Hb - 14.1gm/dl

TLC - 4300 cells/cumm

PCV - 38 vol%

platelets- 1.50lakhs/cumm

HbA1C - 7.5

26/10/23

Na - 135mEq/L

K - 3.5 mEq/L

Cl- 99mEq/L

Ca - 1.10 mg/dl

Hb - 12.2gm/dl

TLC - 11300 cells/cumm

PCV - 32.5 vol%

Platelets - 2.70 lakhs/cumm

27/10/2023

Hb - 12.3gm/dl

TLC - 6400cells/cumm

platelets - 2.08 lakhs/cumm

Na - 130mEq/L

K - 4.4 mEq/L

Cl - 96 mEq/L

Ca - 1.09mg/dl

ABG analysis

pH - 7.32

pCO2 - 32.7mmHg

pO2 - 45.7 mmHg

HCO3 - 16.4mEq/L

PROVISIONAL DIAGNOSIS

DIABETIC KETOACIDOSIS with pyrexia under evaluation k/c/o DM II since 5 years

TREATMENT

25/10/23

Inj.Human actrapid insulin 6 units IV/ Stat 

          1ml insulin [HAI] 6units stat

IV fluids NS @ 100ml/hr

IV fluids 5% dextrose - to maintain dextrose

Tab.Dolo 650mg PO/TID

Monitor GRBS hourly

Monitor Vitals hourly

26/10/23

Inj Monocef 1gm IV/BD

Inj.Human actrapid insulin 6 units IV/ Stat 

          1ml insulin [HAI] + 39ml NS

Inj.Dextrose IV

IV fluids NS @ 100ml/hr

Monitor Vitals hourly

Inj.H actrapid

Inj.NPH insulin

27/10/23

Inj Monocef 1gm IV/BD

IV fluids NS @ 100ml/hr

Inj.Human actrapid insulin TID

Inj.NPH insulin sc SOS acc to GRBS

Inj.Pan 40mg IV/OD/BBF

Inj Neomol 1 gm IV/SOS if temp is 101F

Monitor GRBS

Monitor vitals.