GM SHORT CASE FINAL PRACTICE EXAMINATION

 pain abdomen secondary to uncontrolled sugars with DKA with ? pancreatitis with AKI on CKD. (CKD secondary to metabolic acidosis ) with HFPEF with metabolic acidosis secondary to DKA & CKD with H/o DM-2 , hypothyroidism , CKD

- February 06, 2022

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CHIEF COMPLIANTS

43 year female came with complaints of lowerback ache pain abdomen & vomitings before 3days

HOPI : Patient was apparently asymptomatic 6 yrs back, then had anasarca , went to hospital in hyderabad & diagnosed to have hypothyroidism 

& also diagnosed as renal failure 

& also DM 2

Currently patient complaining of lower back ache and pain in 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

Renal failure

PERSONAL HISTORY : 

Appetite : decreasd since 6 yrs  

FAMILY HISTORY : Not significantmentrual irregularity since 2yrs

ON EXAMINATION : 

Patient is conscious, coherent, cooperative. 

Pallor + 

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 & I kmm mm

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 

 

ERECT ABDOMENX RAY

CHEST X RAY

REVIEW USG

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 )