52yr old Female with Diabetic Ketoacidosis secondary to GE

 52 year old female who is a farmer by occupation came to the casuality with  

Chief complaints-

-Shortness of breath since afternoon 

-Vomitings since afternoon

-Pain in Abdomen since afternoon

-Discomfort in upper abdomen(Indigestion) since afternoon


HISTORY OF PRESENT ILLNESS :

Patient was apparently asymptomatic initially then developed-

Shortness of breath since afternoon(grade 2 to grade 3) According to NYHA classification 

C/o Vomitings ( 3 episodes food particle as content) , which is non-bilious and non-projectile 

C/o Pain in Abdomen ( diffuse type) associated with loose stools  ( 2 episodes ) which is non-blood stained and non-foul smelling

C/o Dyspepsia since afternoon



PAST HISTORY : 

Similar complaints in the past ( was admitted in our hospital and treated 9 months back ) 

K/c/o DM  since 4 years on insulin (HAI -17 U -x-10U)

N/ k / c /o  HTN , Asthma , Epilepsy , TB 



O/E :  

Patient is conscious,coherent and cooperative

BP:120/60mm Hg 

PR ; 112 bpm  Regular

RR :30 / min

CVS : s1 s2 +

RS : BAE +

P/A: Soft , non-tender





PROVISIONAL DIAGNOSIS: 

Diabetic ketoacidosis secondary to GE 



INVESTIGATIONS: 

19/3/22(Saturday)

Urine for ketone bodies - POSITIVE 



                    10pm     1 am     5 am

PH                6.94.      7.25      7.35

PCO2           9.2          19.9       27.8

PO2              125          87          72.9

HCO3            1.9          8.6         15

St HCO3        5.2         12.3        17.4














20/3/22(Monday)








TREATMENT: 

I. Inj HAI 6 U / IV /stat to Inj.HAI 40 IU in 39ml NS/IV/once 6 ml/hr

2.IVF - ns and rl @ 125 ml/ hr

3.Inj pantop 40mg /IV /OD 

4. Inj zofer 4mg/iv/od

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