A CASE OF DKA PRESENTED IN SUMMER 2023
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I have been given this case to solve in an attempt to understand the topic of "Patient Clinical Data Analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and providing treatment best to our skills and wisdom.
A 50 yr old female patient , who is a housewife came to the OPD with complaints nausea.
Date of admission: 03/06/2023
CHIEF COMPLAINTS
➤ Nausea since 5 days
HISTORY OF PRESENTING ILLNESS
Patient was apparently asymptomatic 1 month back . Then she developed edema in both U/L and L/L , facial puffiness, distension of abdomen.
She was taken to a local practitioner in Nalgonda and diagnosed with Blood Infection ? B/L pneumonia? and was treated conservatively ( Lasik, Lasilactone, Augmentin ) . The symptoms subsided after 10 days .
She had burning micturition 10 days ago , associated with itching.
Then she had decreased appetite and reduced food intake since then . She has complaints of odynophagia and difficulty in swallowing.
She has complaints of nausea since 1 week , associated with one episode of vomitting later . It was non projectile , non bilious , non blood tinged , watery .
She has 3 episodes of stools/day which is non sticky , foul smelling , yellow coloured , less in quantity, not associated with bleeding .
HISTORY OF PAST ILLNESS
➤k/c/o hypertension since 15yrs .
➤Not a K/c/o diabetes mellitus, asthma , epilepsy tuberculosis , CAD.
DRUG HISTORY
Tab. Met XL 25mg PO /OD for Hypertension for last 15yrs .
PERSONAL HISTORY
➤Occupation: Housewife
➤Patient is married .
➤Patient takes mixed diet but has a decreased appetite
➤Bowel and bladder movements are normal
➤No known allergies .
➤ H/O analgesic abuse since 1 yr (prescribed for Osteoarthritis)
➤ No addictions.
Family History
Mother died of blood cancer .
Brother died of heart attack.
General Examination
➤Pallor : seen
➤Icterus : not seen
➤Cyanosis : not seen
➤Clubbing : not seen
➤Lymphadenopathy : not seen
➤Edema : B/L edema in both U/L and L/L .
VITALS
➤Temperature : 99℉
➤PR : 106 beats per minute
➤BP : 100/60 mm of Hg
➤RR : 24 cycles per minute
➤SpO2 : 97% in room air
➤Blood Sugar (random) : 262 mg/dl
PROVISIONAL DIAGNOSIS : DIABETIC KETOACIDOSIS .
INVESTIGATIONS
1) ECG
2) TEST FOR KETONE BODIES
TREATMENT
1) Inj. Human Actrapid Insulin 6U/IV/stat
2) Inj. Human Actrapid Insulin 1ml+39ml/NS at 6ml/hr .
3) IVF NS at 100ml/hr (increase/decrease according to GRBS)
4) Monitoring of GRBS, BP , RR , temp
5) Strict I/O charting .
6) Repeat ABG at 2pm/8am .
