35 YEAR MALE WITH SCHIZOPHRENIA AND DM

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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 CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUT  

DECEMBER 20 , 2021

CHEIF COMPLAINTS:

Patient came to casuality with c/o fever since 5 days on and off , a/w high grade chills 

SOB since 1 day [ grade 3-4 ] Aggrevated since afternoon 


HOPI : PATIENT WAS APPARENTLY ASYMPTOMATIC 4 DAYS   BACK THEN DEVELOPED FEVER  ,WHICH WAS ,ON AND OFF HIGH GRADE ASSOCIATED WITH CHILLS  , A/W SOB (GRADE 3 -4) SINCE ONE DAY AGGREVATED SINCE AFTER NOON AND HE CAME TO KIMS FOR FURTHER EVALUATION NO C/O THERE IS NO HISTORY OF VOMITING ,LOOSE STOOLS ,NO H/O OF COUGH ,NO HISTORY OF PAIN IN ABDOMEN ,ABDOMINAL DISTENSION OR NO HISTORY OF DECREASED URINE OUTPUT


HISTORY OF PAST ILLNESS:

Not K/O/C  HTN , DM , TB , 

H/O SCHIZOPHRENIA Diagnosed at 8 years of age 


PERSONAL HISTORY :

DIET - MIXED ,APPETITE -NORMAL  ,BOWEL MOVEMENT - REGULAR  ,  BLADDER MOVEMENTS - REGULAR  , ADDICTIONS(ALCOHOL AND SMOKING) - NO ADDICTIONS


FAMILY HISTORY - 

NAD



GENERAL EXAMINATION : 

No pallor 

No icterus 

No clubbing 

No lymphadenopathy 

EDEMA is present [feet] 

VITALS:

Temp: Afebrile 

BP: 120/70 mm Hg 

Pulse rate : 90 bpm 

Resp rate : 42 cpm 

spo2: 98% @ RA 

GRBS - 454 mg/dl 

SYSTEMIC EXAMINATION : 

RS : BAE + 

CVS : S1 , S2 +

PA : SOFT , NON TENDER 

CNS: CONSCIOUS 


INVESTIGATION - 


RBS - 352 MG/DL


BLOOD UREA - 27 MG/DL


SERUM ELECTROLYTES  -  SODIUM - 144 MEQ /L , POTASSIUM - 4.7  MEQ /L , CHLORIDE - 98 MEQ / L


COMPLETE URINE EXAMINATION  - ALBUMIN 2+ VALUE DETECTED , URINE POSTIVE FOR KETONES

 

ABG - PH - 7.255 ,PCO2 - 32.8 , HCO3 - 14.1


SEROLOGY -HBSAG -POSITIVE


SERUM CREATININE - 0.6 MG/DL



PROVISIONAL DIAGNOSIS : DIABETES KETOACIDOSIS ? 


CLINICAL IMAGES :



                         DAY 1:

S-


O-O/E PT CONCIOUS 

*BP:120/70 MM HG 

*PR:90 BPM 

*RR: 42 CPM 

*SPO2: 98 %

*CVS: S1 S2 +

*GRBS: 454 mg/dl


A- DIABETIC KETOACIDOSIS

K/C/O SCHIZOPHRENIA

WITH  HbsAg + [D6NOVO]


P- 

1] IVF - NS 1L STAT  @ 250 ml / hr [UPTO 4 HR'S]

2]IVF - NS @ 250 ML / HR [TILL 6 HR']

3]IVF - 5 % DEXTROSE ACCORDING TO GRBS 

4]INJ - MONOCEF 1G/IV/BD 

5]GRBS MONITORING HOURLY 

6]BP MONITORING HOURLY 

7]INJ - HAI 1ML IN 39 ML NS @ 5ML/HR 


                                      DAY 2 : 

S- 

O-O/E PT CONCIOUS 

*BP:140/100 MM HG 

*PR:101 BPM 

*RR: 40 CPM 

*SPO2:80 %

*CVS: S1 S2 +

*GRBS:81 mg/dl


A- DIABETIC KETOACIDOSIS WITH DENOVO DM2

K/C/O SCHIZOPHRENIA

WITH  HbsAg + [D6NOVO]


P- 

1] IVF - NS 1L STAT  @ 250 ml / hr [UPTO 4 HR'S]

2]INJ - NEOMUL 1G/IV/80S [IF TEMP > 101 F ]

3]IVF - 5 % DEXTROSE ACCORDING TO GRBS 

4]INJ - MONOCEF 1G/IV/BD 

5]GRBS MONITORING HOURLY 

6]BP MONITORING HOURLY 

7]INJ - HAI 1ML IN 39 ML NS @ 5ML/HR 

8]TAB PCM 650 MG PO/TID 

9]TAB OLANZAPINE 10 MG PO/OD 

10]TEMP CHARTING 

11]I/O CHARTING 







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