?DKA

This is an online E log book 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 available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 

This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.


Unit 1

Dr. Sravya Kandala
Dr. Navya
Dr. Raheem
Dr. Gnanadha
Dr. Chetana
Dr. Ashfaq

Dr. Charan PGY1
Dr. Chandana PGY1
Dr. Sushmitha PGY2
Dr. Aditya PGY3
Dr. Praneeth PGY3
Dr. Praveen Naik Ass. Prof.
Dr. RAKESH BISWAS HOD


Here is a case I've seen:

18 y/o male presented to casualty with
Chest pain since 2 days.
SOB (Grade III) since 1 day.
Altered sensorium since this morning.

C/o chest pain since 2 days, went to a local RMP 2 days ago and took some injections. Then he developed shortness of breath which aggravated since this morning (Grade III)  along with altered sensorium since this morning.

General Examination

Bp 130/90 mm Hg
PR 146 bpm
Grbs HIGH

CVS
S1 & S2 heard

RS
BAE +, NVBS

PA
Soft, Non-tender, no organomegaly

CNS
Drowsy.
B/L pupils reacting to light.
No signs of meningeal irritation.

                          ABG on admission (11:34 AM)

                         ECG on admission

                           Hemogram on admission


Serial ABGs

             ABG after 3.5 hrs after admission






Provisional Diagnosis
?DKA
?Denovo Type I DM

Treatment
Strict NBM.
IV fluids 2L NS IV Bolus STAT
Inj. HAI 6 u direct IV
Inj. HCO3 50mEq IV STAT
Inj. HCO3 100mEq in 100 ml NS IV slowly over 1hr
Inj. HAI (1 ml in 39 ml NS) IV at 5 ml/hr (0.1 u/kg)
IVF 0.9 % NS, 0.45% NS at 250 ml/hr
Inj. Pan 40 mg IV OD
Inj. Zofer 4 mg IV
Strict hourly GRBS Charting
Strict I/O charting
4th hourly BP/PR/SpO2 monitoring
D1 Inj. Monocef 1g IV BD

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