65 yr old female - DKA

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The patient and the attenders have been adequately informed about this documentation and privacy of the patient is being entirely conserved. No identifiers shall be revealed through out the piece of work whatsoever    

        

    A 65 yr old female, housewife and a resident of Narketpally complaints of fever associated with chills and rigors 10 days back for 4 days  for which she went to a local RMP and diagnosed to have elevated sugar levels and was referred and got admitted in our hospital.

HOPI:

         Patient was apparently asymptomatic 20 yrs back,then she got fever and underwent some tests and diagnosed to have hyperthyroidism for which she is using Neocarbimazole 5mg PO OD

       10 years ago she had fever and decreased appetite for which she went to a local hospital and diagnosed to be type 2 DM and kept on OHA

       10 days back she had high grade fever associated with chills and rigors for about 4 days ,she also had decreased appetite and stopped taking OHA 

      She developed breathlessness since 10 days

     Difficulty in walking and weakness of lower limbs present

     She passed urine and stools in her clothes.

Past history :

Diabetic since 10 years on Insulin 

Hyperthyroidism since 20 years on neocarbimazole 5mg Po OD

Asthma since 20 years .

PERSONAL HISTORY 

DIET mixed 

APETITE  decreased 

SLEEP adequate 

BOWEL AND BLADDER MOVEMENTS involuntary 

ADDICTIONS none

FAMILY HISTORY 

Not significant 

GENERAL EXAMINATION

The patient is coherent conscious cooperative well oriented to time place and person 

She is thin built and moderately nourished 

Pallor absent 

Icterus absent 

Cyanosis absent 

Clubbing absent 

Edema absent

Lymphadenopathy absent 

VITALS 

Pulse 79

BP 120/80

RR 20

Temperature 99.4

Spo2 83%

GRBS 167 

Diagnosis: 

          Diabetic ketoacidosis

Investigations:

           O +ve

  16/8/22

 

 

 

 

 

 

 

  FBS LFT AND LIPID PROFILE

On 18/8/22

 

18/8/22

ABG 

16/8/22

PH 7.347

PCO2 28mmhg

PO2 81.1 mmhg

So2 93.7

HCO3 16.9

GRBS 592

17/8/22 5.42 am

Ph 7.42

PCO2 24.5

Po2 64.2

So2 92.9

HCO3 18.3

18/8/22

Ph7.401

PCO2 26.3

Po2 71.7

So294.6%

HCO3 18.1

20/8/22

Ph 7.47

PCO2 28.9

Po2 68.9

HCO3 20.9

16/8/22

18/8/22

19/8/22

ECG:

  USG:

2D ECHO

Culture and sensitivity 

TREATMENT

Inj HAI 6 ml/hr (from 10pm to 1 am)

              4 ml/hr (from 1 am )

Neocarbimazole 5mg PO OD

Iv NS 100ml/hr

BP/pulse/RR/GRBS charting every 2 hrly