50 yr old female case
Date:5-6-23
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A 50year old female patient who resides at presented to casualty with complaints of pain abdomen 2 days back, regurgitation of food .
HOPI :
Patient was apparently asymptomatic 15 years back then she had a episode of giddiness,was taken to hospital and diagnosed with Hypertension and on regular medication MET-XL25 mg.
Till 6 years back she is doing well developed Bilateral knee joint pain for which she was advised to take anlgesics .
She started to take antacid medication since 4 years
1 month back patient developed facial puffiness,pedal edema was taken to nearby hospital and was told she is having Fatty liver managed conservatively from then she used to develop pedal edema on &off .
Patient complaining of loss of appetite, regurgitation of food, difficulty in swallowing
5 days back
1 episode of vomiting bilious ,non projectile ,food as content
3 episodes of loose stools non sticky,foul smelling, yellow coloured, small quantity,not associated with blood
Abdominal pain squeezing type non radiating , continuous in nature,with no aggravating and relieving factors
Pt presented to casualty on 3/6/23 evening
On checking her GRBS it was found to be HIGH.
URINE for ketone bodies found to be positive.
Past History:
Not a k/c/o Tb, epilepsy,cad,CVD,Asthma, thyroid disorders.
Family History:
Not significant
Personal History:
Pt is having loss of appetite, vowel movements increased ,micturition- 7-8 times /day ,sleep - inadequate,No addictions.
Daily routine:
Patient used to be a maid 6 years back and stopped working due to bilateral knee joint pain and used to stay at home
Patient wakes up at 6:30 am ,does her daily activities and drinks Java at around 7:30 , breakfast by 8 am ,watches Tv will have her lunch by 2 pm ,takes Tea by 6 pm and dinner by 9 pm and sleeps by 10 pm.
General Examination:
Pt is conscious, coherent,cooperative
Pallor present
no icterus,cyanosis, clubbing,generalised lymphadenopathy,edema.
Clinical images:
Bp-130/80 mm Hg
PR-97 bpm
RR-25 cpm
Temperature:Afebrile
Spo2: 98%@RA
GRBS- HIGH
SYSTEMIC EXAMINATION:
P/A:
Inspection:
Abdomen is distended
Infra umbilical vertical scar present
No sinuses,,pulsations, peristalsis.
Umbilicus is central and inverted
All quadrants of Abdomen move equally with respiration.
Palpation:
No local rise of temperature
Tenderness present in the Right ,Left Hypochondrium and Epigastrium.
No fluid thrill
Liver is palpable
Spleen not palpable
Percussion:
Resonant note is heard on percussion
shifting dullness negative
Auscultation:
Bowel sounds are heard.
Cvs:
S1,S2 heard No murmurs
CNS:
No focal neurological deficit
Rs:
Bae+
Normal vesicular breath sounds heard.
Investigations:
URINE for Ketone bodies: Positive
Serum osmolaity:
Glycated Hemoglobin
Abg and serum electrolyte values
Hemogram 
Liver function test:
Usg Abdomen:
No sonological abnormalities detected
Chest X ray:
Provisional Diagnosis:
?Diabetic ketoacidosis ?Starvation ketoacidosis with Acute Gastroenteritis with Denovo DM 2.
Treatment:
1.IVFluids NS @100ml/hr
2.Inj.HAI infusion 1ml(40U)in 39 ml NS@4ml/hr increase or decrease according to GRBS
3.IV 5Dextrose@50ml/hr increase or decrease according to GRBS
4.Strict I/O CHARTING
5.monitor Vitals Hourly
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