CASE OF A 45Yr old male with DKA

February 22, 2022 

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  Cc-45 year old male patient shopkeeper by occupation came to the casuality with chief complaints of   chest pain since 2 days 

HOPI :- 

Patient was apparently asymptomatic  7 years ago 

patient was chronic alcoholic since 20 years , 360 ml / daily ,whisky 

patient  complaints of pain abdomen and was diagnosed with acute pancreatitis 

and diagnosed as DM 2 , similar episodes 2 times , the first one 7 years back and the second one 4 years back.

4 years back is the last episode , had H/0 of irregular insulin intake , came to the casuality in drowsy state and treat for ? DKA

last binge of alcohol 2 days back (90 ml) since then complaining of , chest pain : burning type , radiating to back.

No complaints of palpitations and syncopal attacks 

c/o  sob grade 3-4 , aggravating on talking 

no c/o orthopnea , paroxysmal nocturnal dyspnea 

no c/o burning micturition 

PAST HISTORY :- 

K/C/O DIABETES   since 20 years 

N/K/C/O. HTN,DM, EPILEPSY, CAD  

GENERAL EXAMINATION :- 

Patient was conscious , coperative , coherent 

pallor , icterus, cyanosis, clubbing, lymphadenopathy,edema are ABSENT 

vitals :- 

temp.  afebrile 

BP 120/80 mm hg 

PR 96 bpm.

RR 22 cpm

spo2 100 @RA 

GRBS  468 

SYSTEMIC EXAMINATION :- 

CVS :- S1 , S2 heard 

RS. :- bae present 

P/A : soft , non tender 

CNS :- sensory system intact 

                 motor system.  intact 

                 reflexes

 INVESTIGATIONS:

ECG AS OF : 21/2/2022

ECG AS OF : 22/2/2022

CXR: 

PROVISONAL DIAGNOSIS :- DIABETIC 

KETOACIDOSIS  

TREATMENT :- 

1.Inj HAI  6 U   iv /stat 

2.inj HAI 1ml in 39 ml ns according to infusion algorithm 

3.inj pantop 40 mg iv /bd 

4.inj zofer 4 mg iv /sos