55 yrs old male patient with came with cheif complaints of abdominal pain since 5 days and chest pain since 2 days

 Patient came with cheif complaints of abdominal pain since 4 days and chest pain since 2 days.

Patient was apparently asymptomatic 1 week back and then he consumed alcohol(650ml)  for 2 days continuously and he developed abdominal pain which is dragging type,non radiating, associated with altered sensorium.

C/o chest pain dragging type,non radiating to left arm.

C/o vomiting 3 days back .

Past history:-

Patient is k/c/o DM since 2 yrs and on oral hypoglycemic drugs.

Personal history:-

Alcohol consumption since 30 yrs and currently consumes 650 ml of alcohol daily.

On examination patient is conscious, irritable

Vitals:-

BP- 120/70 mmHg

PR-111bPm

Spo2- 99%at RA.

GRBS- 


5:30-600

7:30- 390

8:30-380

9:30- 383

10:30- 382

11:30- 260

12:30- 210

1:30- 220

2:30- 206

3:30- 207

4:30- 147

5:30- 77

6:30- 121

7:30- 131







Systemic examination:-

CNS- patient is in altered sensorium, irritable and irrelevant talk

INVESTIGATIONS:-











Treatment:-

1. IVF- NS- 1L for 3hrs.

2. Inj HAI 6IU IV/STAT.

3. GRBS monitoring hrly.

4.IVF-5% Dextrose if GRBS<250mg/dl.

5.Inj THIAMINE 100mg in 100 ml NS/IV/BD.

6.Inj OPTINEURON 1 amp in 100ml NS/IV/OD.

PROVISIONAL DIAGNOSIS:-

Diabetic ketoacidosis with known case of diabetes milletus.





 




Comments

Post a Comment

Popular posts from this blog

75 yrs old female patient came with complaints of chest pain associated with shortness of breath and pedal edema

Image
 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. 75 yrs old female patient came with complaints of chest pain associated with shortness of breath and pedal edema Patient was apparently asymptomatic 4 days back and then developed chest pain which is diffuse,non radiating associated with shortness of breath( grade2-3) associated with wheeze and complaints ofpedal edema which is bilateral and pitting type. No H/o Abdominal distension and no H/o decreased urine output. Past history:- not a known case of
Read more

85 yrs old female came to casuality with complaints of weakness of right upper and lower limbs and deviation of mouth to left side and right hemineglect

Image
   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 85 yrs old female came to casuality with complaints of weakness of right upper limb and lower limb and deviation of mouth to left side and right hemineglect Patient was apparently asymptomatic 2 days back and developed sudden onset of weakness of right upper limb and lower limb since yesterday afternoon with deviation of mouth to the left side since yesterday afternoon with right hemineglect+. No history of seizures ,loss of consciousness and GCS on a
Read more

54 yrs old male patient with acute kidney injury secondary to left lower limb cellulitis

Image
54 years old male patient came with chief complaints of shortness of breath and left lower limb swelling since 5 days . H/o present illness:- Patient was apparently asymptomatic 5 days back and then he had a injury to his left leg followed by itching of leg and developed left lower limb swelling associated with shortness of breath ( grade II- III) according to NYHA  classification. No history of chest pain/palpitations. No history of chronic cough/hemoptysis In 2016 patient went to hospital  due to pedal edema where patient had? Ischemic encephalopathy followed by 4 sessions of dialysis was done and discharged not as any medications after that. Past history:- Patient is not a k/c/o Dm, asthma, epilepsy hypertension. Personal history: Diet-mixed  Appetite-decreased Bowel and bladder movements-regular Daily alcohol consumer 5 years back,stopped 5 years back and recently he had 100 ml of alcohol General examination: Patient is conscious, coherent, cooperative . Pallor + No icterus,cyanosi
Read more