DIABETIC KETOACIDOSIS [RESOLVED] WITH DENOVO DIABETES MELLITUS SECONDARY TO ACUTE ON CHRONIC PANCREATITIS

 Case History and Clinical Findings

C/O PAIN ABDOMEN SINCE 3 DAYS. PATIENT WAS APPARENTLY ASYMPTOMATIC 3 DAYS AGO THEN HE DEVELOPED PAIN ABDOMEN SINCE 3 DAYS INSIDIOUS IN ONSET, LEFT LUMBAR REGION, SPASTIC TYPE OF PAIN,NON RADIATING.

A/W VOMITING 3 EPISODES PER DAY

A/W LOSS OF APPETITE SINCE 3 DAYS

H/O CONSTIPATION SINCE 3 DAYS,STEATORRHOEA

H/O BLOATING

NO H/O FEVER ,LOOSE STOOLS

NO H/O BURNING MICTURITION

NO H/O DECREASED URINE OUTPUT

PAST HISTORY:

H/O SIMILAR COMPLAINTS IN THE PAST

N/K/C/O HTN,DM,CVA,CAD,EPILEPSY,ASTHMA

NO PALLOR ,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY,PEDAL EDEMA.

VITALS:

BP:130/80

TEMP:97

RR:31

COURSE IN HOSPITAL:

THIS IS A CASE OF 36 YR OLD MALE CAME WITH C/O PAIN ABDOMEN SINCE 3 DAYS A/W VOMITINGS 3-4 EPISODES PER DAY.PATIENT WAS EVALUATED AND DIAGNIOSED WITH DIABETIC KETOACIDOSIS,ACUTE O CHRONIC PANCREATITIS

PATIENT WAS ADVISED FOR CECT ABDOMEN I/V/O PANCREATITIS BUT PATIENT AND ATTENDR DENIED FOR IT. ANTIBIOTICS ADEQATE,REHYDRATION WITH FLUIDS,SUGAR CONTROL WITH INSULIN DRIP F/B INSULIN S/C INJECTION .PATIENT CONDITION IMPROVED AND VITALS ARE STABLE AT THE TIME OF DISCHARGE

PROVISIONAL DIAGNOSIS

DIABETIC KETOACIDOSIS [RESOLVED] WITH DENOVO DIABETES MELLITUS

SECONDARY TO ACUTE ON CHRONIC PANCREATIT

Investigation

ABG 19-04-2024 06:08:AM PH7.12PCO27.2PO2129HCO32.3St.HCO37.1BEB-28.4BEecf- 26.4TCO24.7O2 Sat96.1O2 Count23.0COMPLETE URINE EXAMINATION (CUE) 19-04-2024 07:04:AM COLOURPale yellowAPPEARANCEClearREACTIONAcidicSP.GRAVITY1.010ALBUMIN+SUGAR+++BILE SALTSNilBILE PIGMENTSNilPUS CELLS3-4EPITHELIAL CELLS2-3RED BLOOD CELLSNilCRYSTALSNilCASTSNilAMORPHOUS DEPOSITSAbsentOTHERSNilHBsAg-RAPID19- 04-2024 07:04:AMNegative Anti HCV Antibodies - RAPID19-04-2024 07:04:AMNon Reactive BLOOD UREA19-04-2024 07:04:AM38 mg/dl42-12 mg/dlSERUM CREATININE19-04-2024 07:04:AM0.7 mg/dl1.3-0.9 mg/dlSERUM ELECTROLYTES (Na, K, C l) 19-04-2024 07:04:AM SODIUM133 mmol/L145-136 mmol/LPOTASSIUM5.0 mmol/L5.1-3.5 mmol/LCHLORIDE101 mmol/L98-107 mmol/LLIVER FUNCTION TEST (LFT) 19-04-2024 07:04:AM Total Bilurubin1.20 mg/dl1-0 mg/dlDirect Bilurubin0.18 mg/dl0.2-0.0 mg/dlSGOT(AST)12 IU/L35-0 IU/LSGPT(ALT)13 IU/L45-0 IU/LALKALINE PHOSPHATASE205 IU/L128-53 IU/LTOTAL PROTEINS6.2 gm/dl8.3-6.4 gm/dlALBUMIN3.4 gm/dl5.2-3.5 gm/dlA/G RATIO1.21SERUM AMYLASE19-04-2024 07:04:AM88 IU/L140-25 IU/L

HAEMOGRAM - 19-4-24

HAEMOGLOBIN - 13.9 gm/dl

TOTAL COUNT - 17,400 cells/cumm

NEUTROPHILS - 89 %

LYMPHOCYTES - 03 %

EOSINOPHILS - 01 %

MONOCYTES - 7 %

BASOPHILS 00 %

PCV - 38.3 VOL%

MCV - 92.5 fl

MCH -33.6 pg

MCHC - 36.3 %

RDWCV 12.3 %

RDWSD 42.4 fl

RBC COUNT - 4.14 millions/cumm

PLATELET COUNT - 3.94 lakhs/cumm

SMEAR

RBC - NORMOCYTIC NORMOCHROMIC

WBC - COUNTS INCREASED ON SMEAR WITH NEUTROPHILS

PLATELETS - ADEQUATE IN NUMBER AND DISTRIBUTION

HAEMOPARASITES - NO HAEMOPARASITES SEEN

IMPRESSION - NORMOCYTIC NORMOCHROMIC BLOOD PICTURE WITH NEUTROPHILIC LEUKOCYTOSIS

BLOOD - SUGAR FASTING

FBS - 399 mg/dl

HIV 1/2 RAPID TEST

NON REACTIVE

GLYCATED HAEMOGLOBIN

HBA1C - 7.2 %

LIPID PROFILE

TOTAL CHOLESTROL- 150 mg/dl

TRIGLYCERIDES - 171 mg/dl

HDL CHOLESTROL - 35 mg/dl

LDL CHOLESTROL - 76 mg/dl

VDL - 34.2 mg/dl

HEMOGRAM - 20/4/24

HB-13.8

TC -13200

PLT-3.23

HEMOGRAM 22/4/2024

HB -12.6

TC-9900

PLT-3.29LAKH

ABG 20/4

PH -7.34

PCO2 -22.8

PO2 -40.9

HC03-12.0

SERUM LIPASE - 53

Treatment Given(Enter only Generic Name)

IVF 2PINT NS BOLUS

IVF NS 100ML/HOUR

INJ PAN 40MG IV/OD

INJ THIAMINE 200MG IN 100ML NS IV/BD

INJ HAI (1ML) IN 39ML NS 6ML/HR INCREASE/DECREASE ACCORDING TO GRBS

INJ HAI 40U 6U-6U-6U S/C TID

INJ NPH 6U-X-6U S/C BD

INJ MONOCEF 1GM IV /BD FOR 5 DAYS

SYP CREMAFFIN 10 ML PO HS

Advice at Discharge

PLENTY OF ORAL FLUIDS

STRICT DIABETIC DIET

TAB METFORMIN 500MG PO BD CONTINUE

TAB PAN 40MG PO OD FOR 7 DAYS

TAB BENFOMET PLUS PO BD FOR 15 DAYS

SYP CREMAFFIN 10ML PO HS

Follow Up

REVIEW AFTER 7 DAYS OR SOS