Medical Logbook by Raveela. N

 Case of 21/M Viral Pyrexia associated with DKA

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 E log book also reflects my patient-centred online learning portfolio and your valuable comments on comment box are welcome.
Name : Raveela 
Roll no : 95
Batch  :2017
Case Presentation
Cheif complaints: 21/M  resident of miryalaguda was bought to the casuality with  complaits of Fever since :5 days, c/o decreased appetite:7 days c/o vomiting since 1 day, c/o sob since morning
HopI: Patient was apparently asymptomatic 5 days back  then he developed fever which was insidious in onset, high grade, intermittent a/w chills and relieved on medication . Patient had H/o 1 episode of vomiting 1 day back which was non- bilious,non-projectile.
No h/o any burning micturition, throat pain, cold,cough.

Not a k/c/o HTN,DM, CAD, asthma, TB, epilepsy.

Personal History:
Patient has mixed diet with normal appetite and adequate sleep. 
he has normal bowel movements and bladder filling. 
No addictions. 

No significant family history or allergic history. 

General Examination:
Patient is c/c/c ,moderately built and moderately nourished. 
No pallor, icterus, cyanosis, clubbing, lymphadenopathy, pedal edema
VITALS
BP: 140/90 MMHG, 
PR: 120bpm 
Temp: 98.2°F, 
RR: 40 CPM, 
SPO2: 99% 
Systemic Examination
RS: BAE+,NVBS heard
CVS: S1 ans S2 heard. No murmurs.No thrills
P/A: soft and non-tender. 
CNS: No focal deformities. 
Investigations:
Haemogram:
Hb: 8.2
TLC: 15800
N:89
L:6
PCV: 30
Mcv:63.7
MCH:17.4
MCHC:27.3
PLC:3.37
RBC:4.71
2) Liver Function Test

3) Complete urine examination

4) Random blood sugar:194mg/dl

5) Blood Urea




6) Serum Creatinine:

7) Urine for ketone bodies

8) ABG@2pm


9) Serum electrolyte:@2pm


Serum electrolyte @10 pm
10)Chest xray PA view:


 Provisional Diagnosis:
DIABETIC KETOACIDOSIS
With denovo detected diabetes mellitus with viral Pyrexia  under evaluation. 
TREATMENT:
On DAY-1
1)NBM till further orders
2)IVF 3lit NS @500ml/hr(in 3hrs) f/by IVF NS@250ml/hr 
3)Inj. HAI 4IU IV/stat f/b Inj. HAI 1ml (40IU) in 49ml NS @ 4ml/hr(untill ABG correction)
4)Inj. PAN 40mg IV/OD
5)IVF 5%DEXTROSE @50-100ml/hr(when GRBS <150) [increase/decrease acc. to GRBS]
6)Inj.OPTINEURON 1amp in 100ml NS/IV/OD 
7)GRBS monitoring hourly
8) Strict i/o. Monitoring
9)Inj. KCl 2amp in 500ml NS @100ml/hr

On DAY-2 :
SOAP NOTES:

S: 
No fever spikes,sob decreased ,no fresh complaints
O:
BP-110/90mm hg
PR-74bpm
CVS:S1S2 heard
Rs:BAE +,NVBS
P/A:soft
A:
HAGMA, DKA
Hemogram:


ABG @ (1am) 

@8AM

@3PM

SERUM ELECTROLYTES: @8am

@5pm
  


@10:30pm

P:


DAY-3 :
S: Patient sob decreased,No fresh complaints

O: BP 110/80 mm hg
PR: 70 bpm
CVS: s1 s2 heard 
RS: BAE+ NVBS 
P/A: soft 
ABG@6.30AM

Serum electrolyte @ 8Am


Assesmemt : over night patient grbs around 290 mg/dl and Patient anion gap is reducing day by day and subjectively feeling better .

Plan of care : Look for today morning abg and stop iv insulin infusion and start him on NPH and HAI

Brief  case history by Dr. Ranjith. 
https://ranjith119.blogspot.com/2021/10/diabetic-ketoacidosis-with-denovo.html










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