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.





 




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