60 year old female diabetic ketoacidosis case

This is an online E logbook to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through series of inputs from an available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs

 60-year female came to the opd with complaints of pain in the right side of chest since 2 days, shortness of breath since today evening , low-grade fever since 2 days back, headache since 2 days , generalized body pains since 3 days, and mild pedal edema since 1 year

HOPI:-

the patient was apparently asymptomatic 3 days back, then developed chest pain, which was on the right side, nonprogressive, relieved by sitting position, right lateral position, and associated with headache, generalized weakness, shortness of breath on exertion.

PAST HISTORY - 

h/o DM, HTN , no h/o asthma  CAD,TB or any surgeries.

PERSONAL 

diet-mixed, appetite -normal, B&B- regular, sleep- adequate.

no h/o of tobacco or alcohol and no h/o of allergies.


Physical examination:-

no signs of pallor, icterus , cyanosis, clubbing, koilonychia or lymphadenopathy.

temp- 98.4F, pulse rate- 101bpm, RR- 20cpm, BP- 110/70mmhg.

Hands cold and clammy.


CVS examination:-

S1 S2 heard

no murmurs heard

Altered mental status present


CNS examination:-

the patient was conscious and alert, oriented to time, place, and person

speech - normal 

no signs of meningeal irritation

sensory and motor system is normal

Gait - normal

reflexes- intact


Respiratory examination:-

no h/o of dyspnea, wheezing 

position of trachea- central.

Acidotic breaths present


PROVISIONAL DIAGNOSIS:- viral pneumonia associated with Diabetic ketoacidosis with type 2 DM and HTN.


INVESTIGATIONS:- 

Hemogram, CUE, CXR-PA view, ABG, RFT, LFT, urine for ketones.

TREATMENT:-

1) INJ. LASIX- 40MG 

2) INJ. AUGMENTIN

3)INJ. PAN-40 MG

4)O2 INHALATION if spO2 is <95%

5)T. AMLONG 5MG

6)T. TELMA 40MG

7)T. ECOSPORIN 325MG

8) T. CLOPIDO300MG

9)T. ATOVAS 80MG

10)INJ. HEPARIN5000IU

11) INJ 39ML NS with 40 IU HAI@6ML/HR


DEATH SUMMARY:-

DEATH SUMMARY: A 60/F CAME TO CASUALTY WITH C/O SOB, WITH LOW GRADE FEVER SINCE TWO DAYS WHICH INCREASED SINCE 6 HOURS, WITH RIGHT SIDED CHEST PAIN.


K/C/O DM2,HTN SINCE 10 YEARS ,PRESENTED WITH GRBS. 500MG/DL, WITH TACHYPNOEA,ALTERED MENTAL STATUS, DIAGNOSED AS DKA WITH? SEVERE METABOLIC ACIDOSIS WITH VIRAL PNEUMONIA, WITH HRCT CHEST SHOWING CORADS 4; SPO2:85% ON RA, PP:52/MIN,BP:140/90MMHG.PR;68/MIN


PATIENT WAS ADMITTED IN COVID WARD IN VIO? VIRAL PNEUMONIA AND RESUSCITATED ACCORDINGLY WAS SHIFTED TO MEDICAL ICU FOR FURTHER MANAGMENT


TREATED WITH IV INSULIN, SODIUM BICARBONATE,FLUIDS,ANTIPLATELETS AND STATUS WAS DONE


THE PATIENT BECAME UNRESPONSIVE WITH NO CENTRAL PULSES, WITH SPO255% ON R, ECG MONITOR SHOWING COMPLETE HEART BLOCK WITH BP: NOT RECORDABLE


CPR WAS INITIATED, AT 12:30 PM,BUT IN SPITE OF ALL EFFORTS PATIENT COULDNT BE RESUSCITATED AND DECLARED DEAD WITH ECG SHOWING NO ELECTRICAL ACTIVITY AT 12:56 PM


IMMEDIATE CAUSE: CARDIO PULMONARY ARREST SECONDARY TO? INFERIOR WALL MI WITH COMPLETE HEART BLOCK


?SEVERE METABOLIC ACIDOSIS WITH DIABETIC KETOACIDOSIS


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