35 yr old male came complaints of vomitings and loose stools

GENERAL MEDICINE CASE

"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 patients 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 comment box is welcome


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C/o vomitings since 6 days- 5-6 episodes/day, food as content, c/o loose stools 2 episodes 6 days back, c/o fever since 3 days.

Patient was apparently asymptomatic 4yrs ago,he is a alcoholic,drinks daily 90-180ml since the age of 20yrs. H/o SOB, pain abdomen 4yrs ago came to our hospital and diagnosed with chronic atrophic, calcific pancreatitis and secondary diabetes mellitus ( ketone bodies +)and was started on insulin. Continued to take alcohol,on and off pain abdomen+, complaints of vomitings 5-6 episodes/day since 6 days food as content, complaints of loose stools-2 episodes 6days ago.

Complaints of high grade fever since 3 days, not associated with chills. No c/o burning micturitionP.atient complaints of shortness of breath since today afternoon.

Patient went to local RMP 3days back was advised to stop insulin and take metformin 500mg OD since 3 days.

Past history:-

Diabetes milletus since 4yrs

Chronic pancreatitis since 4yrs.

O/E 


PT- C/C/C

temp- 98.6oF

BP -110/70

PR -86

GRBS- 432MG/DL

SpO2- 99%at RA 


CVS -S1 S2 heard

RS -BAE present, NVBS heard

PA- soft non tender

CNS- NAD.






INVESTIGATIONS:-


















Provisional diagnosis:-


DKA secondary to irregular insulin 


Treatment:-

IVF 2UNITS NS IV BOLUS,INJ HAI 4UNITS IV STAT

INJ PAN 40 MG IV OD.

INJ ZOFER 4MG IV BD 

IVF NS,RL @100ML/HR.

HOURLY GRBS MONITORING

INJ HUMAN ATRAPID INSULIN@4ML/HR WITH HOURLY GRBS MONITORING.

TAB DOLO 650 MG PO TID.

TAB NEOMOL 1GM IV SOS.

BP/PR/TEMP MONITORING.










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