pain abdomen secondary to uncontrolled sugars with DKA with ? pancreatitis with AKI on CKD. (CKD secondary to metabolic acidosis ) with HFPEF( EF- 58%) with metabolic acidosis secondary to DKA & CKD with H/o DM-2 , hypothyroidism , CKD
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43 year female came with complaints of pain abdomen & vomitings since 1 day
HOPI : Patient was apparently asymptomatic 6 yrs back, then had anasarca , went to hospital in hyderabad & diagnosed to have hypothyroidism ( started on tab.THYRONORM 50 micrograms)
& also diagnosed as renal failure & was on TAB.TORSEMIDE 20MG+ SPIRONOLACTONE 50MG
& also DM 2 ( started on inj.MIXTARD 6U....X...10U & increased doses of MIXTARD to 20U...X...25U since 1 1/2 yr.
Currently patient complaining of pain abdomen which is diffuse , intermittent, dull aching pain associated with vomitings, 2 episodes non bilious , non projectile , food as content .
No H/O fever, cold, cough, loose stools, constipation , malena, haematuria
No H/O pedal edema, decreased urine output, facial puffiness,
PAST HISTORY :
k/c/o DM 2 since 6yrs ( using INJ.MIXTARD 20U...X....25U)
Hypothyroidism since 6yrs ( TAB.THYRONORM 25microgram)
N/k/c/o of HTN, bronchial asthma, epilepsy, tb
TREATMENT HISTORY :
1) DM 2 since 6yrs ( using INJ.MIXTARD 20U...X....25U)
2)Hypothyroidism since 6yrs ( TAB.THYRONORM 25microgram)
PERSONAL HISTORY :
Diet : mixed
Appetite : decreasd since 6 yrs
Sleep : adequate
Bowel & bladder : regular
No known addictions.
FAMILY HISTORY : Not significant
ON EXAMINATION :
Patient is conscious, coherent, cooperative.
Pallor +
Icterus,clubbing, cyanosis , koilonychia, edema are absent
VITALS
Temp- Afebrile
Bp-150/80 mm hg
Pr- 88bpm
Rr-21cpm
Spo2- 99% on RA
Grbs : High
SYSTEMIC EXAMINATION :
RS- decreased breath sounds on B/L IAA & ISA
Cvs-S1 S2 +
P/A - soft, diffuse tenderness +
Cns- NAD
GCS - 15/15
INVESTIGATIONS : (3/2/22)
ABG :
PH - 7.21
PCO2- 25.8
PO2- 89.2
HCO3- 12
RBS : 560MG/DL
HBA1C : 8.1
HEMOGRAM :
HB: 9.4
TLC : 13,200
RBC : 3.47million/cu3
Urine for ketone bodies : negative
RFT :
sr cr : 4.6
Urea : 4.6
Na+ : 131
K+: 4.6
LFT :
SGPT : 125
SGOT : 137
ALP : 372
TP: 5.5
ALB : 2.7
Sr. Amylase : 237
Sr. Lipase : 92
USG ABDOMEN :
1.GB wall edema
2.Right mild pleural effusion
3.No ascitis
PROVISIONAL DIAGNOSIS : pain abdomen secondary to uncontrolled sugars with DKA with ? pancreatitis with AKI on CKD. (CKD secondary to metabolic acidosis ) with HFPEF( EF- 58%) with metabolic acidosis secondary to DKA & CKD with H/o DM-2 , hypothyroidism , CKD
TREATMENT PLAN:
ON 3/2/22
1)IVF – 0.9%NS 1L FOR 1ST hour
1L FOR 2ND hour
1L FOR 3rd hour
2) IVF – 0.9% NS @ 250ml/hr for next 6 hours
3)INJ. HAI – 0.1IU /KG /B.wt IV /STAT
4)INJ.HAI – 1ml in 39ml NS @ 6ml/hr infusion (according to ALGO 1 )
5 INJ. PANTOP 40mg IV/OD
6)INJ.ZOFER 4mg IV/SOS
TREATMENT ON 4/2/22 & 5/2/22
1) IVF – 0.9% NS @ 150ml/hr
2) INJ. PANTOP 40mg IV/OD
3)INJ.ZOFER 4mg IV/TID
4) INJ. METROGYL 500MG /IV / TID
5) INJ. TRAMADOL 1AMP IN 100 ML NS /IV/TID
6)INJ. INSULIN INFUSION WITH 2ML/HR
7)INJ.BUSCOPAN 2CC IV/SOS
8)INJ.LASIX 40MG IV/BD
9) TAB.THYRONORM 50microgram PO/OD
10) PLANNING TO SEND STOOL FOR OVA CYST & CULTURE( i/v/o yellowish green stools )
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