A 20 YEAR OLD FEMALE CAME TO CASUALTY WITH CHIEF COMPLAINTS OF FEVER SINCE YESTERDAY AND ALTERED SENSORIUM SINCE TODAY MORNING.

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A 20 year old female came to casualty with-

CHIEF COMPLAINTS-

 c/o fever since yesterday .

C/o altered sensorium since today morning.

HOPI-

patient was apparently asymptomatic till yesterday, then she developed fever, which is high grade, associated with chills and rigors, no diurnal variation, relieved with medication.

Altered sensorium since today morning.

History of polyphagia and polydypsia

No c/o burning micturition, vomitings, loose stools.

No c/o chest pain, palpitations, orthopnea, PND.

PAST HISTORY- 

Not a k/c/o HTN, DM, TB, asthma, epilepsy, CVA, thyroid disorders.

PERSONAL HISTORY- 

Diet- mixed 

Appetite- normal 

Sleep- adequate 

Bowel and bladder movements- regular 

No known allergies 

Addictions- nil.

FAMILY HISTORY- not significant 

GENERAL EXAMINATION-

patient is conscious, coherent, cooperative. Well oriented to time , place and person, moderately built and moderately nourished 

Vitals - at the time of presentation 

BP- 150/100 mmHg

PR- 113 bpm

RR- 23 cpm

TEMP- 92 F

Spo2- 97%

*****GRBS-  540MG/DL  AT THE TIME OF PRESENTATION.*****

NO SIGNS OF PALLOR, ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY, OEDEMA.

SYSTEMIC EXAMINATION-

1) CVS- S1, S2 heard, no murmurs.

2) RS- BAE present, NVBS 

3) PER ABDOMEN- soft , non tender, no organomegaly 

4) CNS:

Higher mental functions - intact

Cranial nerves - intact

Motor examination - normal  

Reflexes:                    R.               L

Biceps.                        2+              2+

Triceps.                        1+              1+

Supinator                     1+             1+

Knee                             2+              2+

Ankle.                           1+             1+

Plantar.                     Flexor.   Flexor 

Sensory examination:Normal

No meningeal signs

INVESTIGATIONS-

30/9/23-

HEMOGRAM- 

HB-11.1

TLC- 16700

MCV- 85.4

MCH- 26.5

MCHC- 31

PLT COUNT- 3.07

SERUM ELECTROLYTES- 

Sodium- 136

Potassium- 4.2

Chloride- 109

SERUM OSMOLALITY- 287.8 

RBS- 308

SERUM UREA- 30

SERUM CREATININE- 0.8

CUE- 

Sugar++

Albumin +

Bile salts - nil

Bile pigments - nil

Pus cells- 3- 4

Epithelial cells- 2-3

LFT-

TB- 5.3

DB-1.22

AST-19

ALT-10

ALP- 240

TP- 7.1

ABG-

1/10/23                                2/10/23

PH-7.13                                 7.42

PCO2 - 9.7                             19.8

PO2 - 67.2                              117

HCO3 - 3.1                             12.8

ST. HCO3 - 7.3                       16.9

BEB- 26.1                                9.5

O2 SAT- 93.4                           98.1

1/10/23-

SERUM ELECTROLYTES-

SODIUM- 133

POTASSIUM- 4.1

CHLORIDE- 104

PLBS- 263.

URINARY KETONE BODIES- POSITIVE 

LDH- 579

COOMBS( direct and indirect) - negative 

HBA1C- 7.0

ECG-

ULTSOUND- 

PROVISIONAL DIAGNOSIS - DIABETIC KETOACIDOSIS WITH DENOVO DM TYPE 2

TREATMENT-

1. INJ. HUMAN ACTRAPID INSULIN 1ML IN 39ML NS @ 6ml/hr

2. IV. FLUIDS NS @ 75ml/hr

3. INJ. MONOCEF 1GM IV/BD

4. INJ. PAN 40MG IV/OD

5. INJ. ZOFER 4MG IV/SOS

6. GRBS 7 PROFILE MONITORING.

BP CHARTING-