C/O SOB, FEVER, RASH OVER THE ABDOMEN

 Case History and Clinical Findings

C/O SOB SINCE 2 HRS

FEVER SINCE 8 HRS

RASH OVER THE ABDOMEN SINCE 3 DAYS

PATIENT WAS APPARENTLY ASYMPTOMATIC 2 HRS BACK THEN SHE DEVELOPED SUDDEN ONSET SOB GRADE 4

NO ORTHOPNEA/PND ,CHEST PAIN,PALPITATIONS,PEDAL EDEMA ,EXCESSIVE SEATING,GIDDINESS,WHEEZE

PT IS K/C/O TYPE 1 DM ,MISSED 2 DOSES OF INSULIN

1 EP OF FEVER HIOGH GRADE A/W CHILLS AND RIGORS

RASH OVER THE ABDOMEN SINCE 3 DAYS INITIALLY SMLL IN SIZE LATER PROGRESSED TO CURRENT STATE .H/O APPLYING PCM PASTE TO LESION

NO H/O VOMITING,LOOSE STOOLS ,PAIN ABDOMEN,GIDDINESS

PAST HISTORY : K/C/O TYPE 1 DM SINCE 3 YRS ON NPH,HAI INSULIN

H/O RT HUMERUS FRACTURE ,TREATED CONSERVATIVELY

NOT K/C/O HTN,ASTHMA,TB

O/E

PATIENT IS CONSCIOUS,COHERENT,COOPERATIVE

NO SIGNS OF PALLOR,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY,PEDAL EDEMA

VITALS ;

TEMP-98.8

BP-110/60 MMHG

PR-158 BPM

GRBS-HIGH

SPO2-98 ON RA

CVS :S1,S2 HEARD,NO MURMURS

RS:BAE +,NVBS

CNS: NAD

P/A :SOFT,NON TENDER ,BOWEL SOUNDS+

DERAMTOLOGY REFERRAL DONE ON 14/07/23 I/V/O RASH ON ABDOMEN

DIAGNOSIS:POST INFLAMMATORY HYPERPIGMENTATION

TREATMENT GIVEN :

1.T BACT OINT LA BD FOR 1 WEEK

2.VENUSIA MAX LOTION LA BD FOR 2 WEEEKS

COURSE OF STAY:

14 YEAR OLD PATIENT PRESENTED WITH ABOVE COMPLAINTS. PATIENT WAS EVALUATED CLINICALLY AND WITH APPROPRIATE INVESTIGATIONS. PATIENT WAS ORIGINALLY DIAGNOSED WITH DKA , IMMEDIATE FLUID RESUSCITATION OF 3 L WAS DONE , IV INFUSION WAS STARTED . PATIENT WAS ON INSULIN INFUSION PUMP FOR 24 HOURS LATER BRIDGED TO INJECTION HAI AND NPH.

OPHTHALMOLOGY OPINION WAS TAKEN I/V/O DIABETIC RETINOPATHY AND NO CHANGES ARE SEEN.

DERMATOLOGY OPINION TAKEN I/V/O HYPERPIGMENTED RASHES OVER ABDOMEN WITH VESICLES AND THEIR ADVISED FOLLOWED.

ENDOCRINOLOGY OPINION WAS TAKEN AND THEIR ADVISED 2WAS FOLLOWED.

PATIENT HAS IMPROVED SYMPTOMATICALLY AND DISCHARGED IN STABLE CONDITION.


Provisional Diagnosis:-

DIABETIC KETOACIDOSIS (RESOLVED)SECONDARY TO NON COMPLIANCE TO TREATMENT K/C/OTYPE 1 DM SINCE 3 YRS

WITH POST INFLAMMATORY HYPERPIGMENTATION.


Investigation:-

URINE FOR KETONE BODIES -POSITIVE

HB -13.1 MG/DL

TLC-29500 /CUMM

N/L-78/17

PLT COUNT-1.5 LAKH/CUMM

RBC-3.31 MILLION/CUMM

UREA-30 MG/DL

S.CREAT-0.9 MG/DL

URIC ACID-7.2 MG/DL

NA-126 MEQ/L

K-4.9 MEQ/L

CL-90 MEQ/L

TB/DB-6.47/0.56

SGOT/SGPT-42/44

ALP-406

TP-6.6

A/G-1.6

Treatment Given(Enter only Generic Name)

1.IVF NS BOLUS F/B NS 150 ML /HR

2.INJ HAI INSULIN 8 IU STAT

3.INJ HAI 40 IU IN 39 ML NS @ 6 ML /HR

4.IVF 5D @ 50 ML/HR IF GRBS <200 MG/DL

5.INJ PANTOP 40 MG PO/OD

6.INJ NEOMOL 1 GM IV /SOS (IF TEMP >101 F )

7.TAB PCM 650 MG PO/SOS

8.STRICT INPUT/OUTPUT CHARTING

9.GRBS MONITORING

10 MONITOR VITALS 4 TH HOURLY



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