A 35 year old male with chief complaints of vomiting and tachypnea.

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Chief complaints: 

Patient was admitted to the hospital on 7th sept, 2022 with complaints of vomiting (4-5 times), watery in consistency, since previous day of admission. Non blood stained. 

Mild pain in the flanks, intermittent since the onset of chief complaints. Stabbing type of pain. 

Increased respiratory rate. 

History of present illness:

He went to the local practitioner and got his blood sugar levels checked. It was around 580mg/dl, since  then there was no intake of food. Also there is drastic weight loss since the past 10 days. At present, his sugar levels are being monitored and a rapidly acting insulin  (Actrapid 40IU/ml) was given. 

History of past illness:

Patient diagnosed with Diabetes Mellitus Type - 2 about 2-3 years ago.

2 years ago there was increasing micturition at night for which he went to the hospital for a general check up, then he was diagnosed to be a diabetic. He took his last tablet 3 days ago. 

Addictions:

Known alcoholic since  10 years. Alcohol amount consumed - a quarter everyday.He used to consume beer too ( 2 glasses per day). Also a beedi smoker (1 pack lasts upto 3 or 4 days).

Toddy consumer since childhood(1 litre every week, weekly once). 

Family history: 

The patient's father is a diabetic. The father had an episode of stroke in his past and then his hands where paralyzed. Currently he's gradually recovering. 

Surgical history: negative. 

Drug history : currently on treatment for diabetes. 

Personal history: 

not a known case of TB, asthma, hypothyroidism. Negative cancer history. No previous history of blood transfusions. No previous history of contracting covid. 

 

Patient is consious and coherent. Oriented to time, place and person. 

Sleep pattern normal and adequate. Loss of appetite present, weight loss present. 

Normal bowel movements. No burning micturition.

General examination: 

Pallor negative

Icterus negative

Cyanosis negative

Clubbing of digits negative

Lymphadenopathy absent

And Edema absent. 

Per abdomen : normal, no distended veins, or scars present, no organomegaly. 

Vitals: 

Temperature afebrile.

RR : 45 

Pulse 

SpO2 91%

BP : 90/70 mmhg. 

Systemic examination: 

RS - NVBS heard. No wheezing or crackles and BAE present. 

CVS- normal S1, S2 heard. Apex beat heard. 

CNS- HMF +.

Laboratory investigations. 

Hb 14.5, PCV 43.9  TLC 23,000 RBC 5.03 Platelet count 3.3 ESR N/L/E/M 75/23/3/2/0  Blood Urea 67 S.Creatinine 1.8 S.Na+ 137 S.K+ 5.0 S.CI 104.

T Bilirubin 1.39 D. Bilirubin 0.74 L. Bilirubin SGPT 35 SGOT 49, Alk. Phosphate 218  T. Proteins 6.9 Albumin 3.97. Globulin  A/G Ratio 1.35 CUE/Ketones +++ve. Pus Cells 2-4. S. Calcium 2-3.D dimers present +++.

2 D echo :

Probable diagnosis: DKA 

Treatment