pain abdomen secondary to uncontrolled sugars with DKA with ? pancreatitis with AKI on CKD. (CKD secondary to metabolic acidosis ) with HFPEF( EF- 58%) with metabolic acidosis secondary to DKA & CKD with H/o DM-2 , hypothyroidism , CKD

43 year female came with complaints of pain abdomen & vomitings since 1 day


HOPI : 

Patient was apparently asymptomatic 6 yrs back, then had anasarca , went to hospital in hyderabad & diagnosed to have 
hypothyroidism ( started on tab.THYRONORM 50 micrograms) 
& also diagnosed as 
renal failure & was on TAB.TORSEMIDE 20MG+ SPIRONOLACTONE 50MG
& also DM 2 ( started on inj.MIXTARD 6U....X...10U & increased doses of MIXTARD to 20U...X...25U since 1 1/2 yr. 

Currently patient complaining of pain abdomen which is diffuse , intermittent, dull aching pain associated with vomitings, 2 episodes non bilious , non projectile , food as content . 
No H/O fever, cold, cough, loose stools, constipation , malena, haematuria
No H/O pedal edema, decreased urine output, facial puffiness, 



PAST HISTORY :  

k/c/o DM 2 since 6yrs ( using INJ.MIXTARD 20U...X....25U) 

Hypothyroidism since 6yrs ( TAB.THYRONORM 25microgram)

N/k/c/o of HTN, bronchial asthma, epilepsy, tb



TREATMENT HISTORY :

 1) DM 2 since 6yrs ( using INJ.MIXTARD 20U...X....25U)


2)Hypothyroidism since 6yrs ( TAB.THYRONORM 25microgram)


PERSONAL HISTORY : 

Diet : mixed 
Appetite : decreasd since 6 yrs 
Sleep : adequate 
Bowel & bladder  : regular 
No known addictions.


FAMILY HISTORY : Not significant



ON EXAMINATION : 

Patient  is conscious, coherent, cooperative. 

Pallor + 

Icterus,clubbing, cyanosis ,  koilonychia, edema are absent


VITALS 
Temp- Afebrile 
Bp-150/80 mm hg
Pr- 88bpm
Rr-21cpm
Spo2- 99% on RA
Grbs : High



SYSTEMIC EXAMINATION : 


RS-  decreased breath sounds on B/L IAA & ISA 

Cvs-S1 S2 +

P/A - soft,  diffuse tenderness + 

Cns-   NAD 
GCS - 15/15



INVESTIGATIONS : (3/2/22)
ABG : 
PH - 7.21
PCO2- 25.8
PO2- 89.2
HCO3- 12

RBS : 560MG/DL
HBA1C : 8.1

HEMOGRAM : 
HB: 9.4
TLC : 13,200
RBC : 3.47million/cu3

Urine for ketone bodies : negative 

RFT :
sr cr : 4.6
Urea : 4.6
Na+ : 131
K+: 4.6

LFT : 
SGPT : 125
SGOT : 137
ALP : 372
TP: 5.5
ALB : 2.7

Sr. Amylase : 237
Sr. Lipase : 92

USG ABDOMEN : 
1.GB wall edema
2.Right mild pleural effusion 
3.No ascitis











Xray erect abdomen on 5/2/22


chest x- ray on 5/2/22





Review usg on 5/2/22



PROVISIONAL DIAGNOSIS :    pain abdomen secondary to uncontrolled sugars with DKA with ?  pancreatitis with AKI on CKD. (CKD secondary to metabolic acidosis ) with HFPEF(EF- 58%) with metabolic acidosis secondary to DKA & CKD with H/o DM-2 , hypothyroidism  , CKD

TREATMENT PLAN: 



ON 3/2/22
1)IVF –  0.9%NS 1L FOR 1ST hour 
                              1L FOR 2ND hour 
                              1L FOR 3rd hour   
2) IVF – 0.9% NS @ 250ml/hr for next 6 hours 
3)INJ. HAI – 0.1IU /KG /B.wt  IV /STAT 
 4)INJ.HAI – 1ml in 39ml NS @ 6ml/hr infusion (according to ALGO 1  )
5 INJ. PANTOP 40mg IV/OD
6)INJ.ZOFER 4mg IV/SOS

TREATMENT ON 4/2/22 & 5/2/22
1)  IVF – 0.9% NS @ 150ml/hr

2) INJ. PANTOP 40mg IV/OD
3)INJ.ZOFER 4mg IV/TID 
4) INJ. METROGYL 500MG /IV / TID
5) INJ. TRAMADOL 1AMP IN 100 ML NS /IV/TID 
6)INJ. INSULIN INFUSION WITH 2ML/HR 
7)INJ.BUSCOPAN 2CC IV/SOS
8)INJ.LASIX 40MG IV/BD
9) TAB.THYRONORM 50microgram PO/OD

10)  PLANNING TO SEND STOOL FOR OVA CYST & CULTURE( i/v/o yellowish green stools ) 







Comments

Post a Comment

Popular posts from this blog

71 yr old male with h/o pyuria since 15days

Image
 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 CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUT.    This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome. 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 diagnosis and treatment plan. A 71yr old male came to opd with chief complaint of  White frothy urine since 15days. History of presenting illness- Patient was asymptomatic 15 days back ,then he developed pyuria since 15days wh
Read more

60yr old with ckd

Image
  60 Year Old with CKD November 10, 2022  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 patient's clinical problems with collective current best evidence based inputs.  This Elog book also reflects my patient-centred online learning portfolio and your valuable inputs on the comment .  11 Nov 2022 A 60 YEAR OLD FEMALE Resident of Narketpally, farmer 20 years ago Chief Complaint Pedal edema since 2 months Shortness of breath since 2 months History of Presenting Illness Patient was apparently asymmtomatic 20 years back then she went for routine check up where they diagnosed her with kidney problem. Since then she is on Sodium bicarbonate twice daily and Calcitriol once daily. 3 years back she had a episode of giddiness, she wa
Read more

44 yr male with ALD

Image
This is a case of 44year old male diagnosed with ALCOHOLIC LIVER DISEASE(ALD)  CHIEF COMPLAINTS  44 year old male came to casualty with chief complaints of fever since 1 week which is high grade and associated with chills and rigors HOPI  Patient was apparently asymptomatic 12 years back, and he had history of intake of alcohol initially 90 ml gradually progress to amount of 200 ml since2 years. Patient was on alcohol which is about 200 ml initially and then the quantity increased to daily intake of 300 ml with no or minimal food intake. He had shortness of breath and also had generalised weakness. Patient became tachypneic over night(RR 18-32cpm) and also had 2 fever spikes and saturation dropped to 82% on RA and also had respiratory distress H/O agressive behaviour previously but now it got subsided  Previously tremors +  Decreased appetite   yellowish discoloration of sclera is present vomiting of 1 episode  patient was admitted in outside hospital and treated as alcoholic liver dis
Read more