Diabetic ketosis

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41 year old female housewife hailing from Miriyalguda came to casualty with C/O:

1) Nausea and vomiting since 10 hrs 

2) Abdominal pain since 10 hrs

1. HISTORY OF PRESENT ILLNESS 

Patient was apparently asymptomatic 10 hours ago then she developed nausea and vomiting, 8-10 episodes of vomiting, content food material watery, non bilious, non projectile, not blood binged associated with Abdominal pain of diffuse type and non radiating.

No H/O chest pain, Pedal edema, burning micturition, coughing, palpitations, excessive sweating, giddiness and wheeze

H/o skipping OHAs since 2 days

2. HISTORY OF PAST ILLNESSES

K/c/o Diabetes Mellitus type 2 since 2 years for which she is on medication (Tab Glimi M1 )

H/o raised blood pressure.

H/o undergoing tubectomy.

No h/o addiction or allergies

3. DAILY ROUTINE:

Patient initially used to wake up at 5:30 am, now she wakes up at around 6 am. She has idli or dosa for breakfast around 7 am. She then does her household chores and has white rice and curry for lunch at around 1:30 pm. She then continues the house hold work or occasionally watches TV till around 7 pm then she starts preparing and has dinner (white rice/roti/howar roti) and goes to bed by around 9 pm.

4. GENERAL EXAMINATION

O/E: 

Patient is concious, coherent and cooperative

No signs of pallor, icterus, clubbing, cyanosis, lymphadenopathy, edema.

Vitals:

BP: 170/110mmhg

PR: 68bpm

RR: 16 cpm

TEMPERATURE: 97.8 F

GRBS: 200 mg/dl

SPO2: 98% at RA

5.CLINICAL IMAGES:

6. SYSTEMIC EXAMINATION:

RESPIRATORY SYSTEM EXAMINATION : 

Bilateral air entry +

Normal vesicular breath sounds heard

Trachea central 

No added sounds 

CVS EXAMINATION : 

S1, S2 heard 

No murmurs 

ABDOMEN EXAMINATION : 

Soft, no tenderness 

No organomegaly

Bowel sounds - present 

CNS EXAMINATION : 

Gcs - E4V5M6 (15/15)

Higher mental functions - normal 

Cranial nerve examination - normal 

Sensory and motor system normal 

No signs of meningeal irritation

7. INVESTIGATIONS:

URINE FOR KETONE BODIES : positive

BLOOD GROUP: B positive

RANDOM BLOOD SUGAR : 200 mg/dl 

HEMOGRAM : 

CUE: 

LFT:

SERUM OSMOLALITY:

BLOOD UREA: 

SERUM CREATININE: 

SERUM ELECTROLYTES: 

ABG:

CHEST X RAY: Normal 

ECG: Normal 

2D ECHO: Normal

ULTRASOUND ABDOMEN:

Impression: Grade 1 fatty liver 

8. PROVISIONAL DIAGNOSIS:

41 year old female diagnosed with Diabetic ketosis with DM type 2.

9. TREATMENT:

INJ. ZOFER 4mg, IV/TID 

INJ. PAN 4Omg, IV/OD 

INJ. HAI, SC/TID (according to GRBS)

IV fluids NS, 100 ml/ hour

Strict GRBS monitoring