55 year old male with Diabetic Ketoacidosis

January 27, 2022

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Chief Complaints:

Abdominal pain since 5 days

Breathing difficulty since 2 days

History of present illness:

Patient was apparently asymptomatic 5 days back then he developed abdominal pain after taking alcohol continuously for 3 days . It is sudden in onset and gradually progressive and dragging type which is aggravated on alcohol intake and relieved on medication. Previously visited other hospitals , after onset of abdominal pain but it didn't relieve inspite of medication .

There is h/o altered sensorium since 3 days . He is unable to identify his wife and pulling away the cannulas.

There is history of nausea where he vomited by inducing with his hand .

There is history of weight loss also since 1 year.

History of sob which is grade 4

History of fever yesterday.

Past history:

A known case of diabetes since 2 years on medication .

History of TB diagnosed 2 months back on regular medication.

Not a known case hypertension,asthma,epilepsy,CVD.

Personal history:

Bowel and bladder - regular and there is increased frequency of urine seen when sugar levels are increased .

Not sleeping adequately since 2 days

Alcohol consumption since 30 yrs occasionally for festivals but he drinks continuously for 3 days of 1 full bottle quantity.

History of tobacco smoking since 25 yrs.

Family history:

Not significant

General examination:

Patient is conscious ,not co operative ,not oriented to time place person

Not well built and nourished .

Afebrile

GCS :

EYE OPENING :4 (opened spontaneously)

VERBAL RESPONSE: 3

MOTOR RESPONSE :3

Total :10

Pallor : present

Icterus : absent

Cyanosis : absent

Clubbing : absent

Lymphadenopathy : absent

Vitals:-

Pulse - 90bpm

RR - 22 cpm

Bp- 140 / 70 mm hg

Temperature- 97.4°c

Spo2- 99%at RA.

GRBS

5:30-600

7:30- 390

8:30-380

9:30- 383

10:30- 382

11:30- 260

12:30- 210

1:30- 220

2:30- 206

3:30- 207

4:30- 147

5:30- 77

6:30- 121

7:30- 131

Systemic examination:-

Examination of oral cavity-

No dental caries, no gum hypertrophy , oral hygiene is maintained , no postnasal drip

Abdominal examination-

INSPECTION:
Shape – scaphoid, flat,not distended
Flanks – free
Umbilicus – Position- central, Shape-inverted
Skin – No scars, no sinuses,no striae, no nodules,no scratch marks,
Dilated veins – not present
All quadrants are equally Movable with respiration ,no visible gastric peristalsis.
No abdominal distension .

PALPATION:
No local raise of temperature.
Superficial Palpation – Tenderness not elicited.

Deep Palpation-

Liver-
Not palpable

Spleen-
Not palpable

Kidney-
Bimanually Not palpable

PERCUSSION:
Fluid Thrill/Shifting dullness/Puddle’s sign - not elicited
Liver span - 6cm

AUSCULTATION:
Bowel sounds are heard.

EXAMINATION OF OTHER SYSTEMS

CARDIOVASCULAR SYSTEM:
S1, S2 are heard.

EXAMINATION OF RESPIRATORY SYSTEM:
Normal vesicular breath sounds heard.

EXAMINATION OF NERVOUS SYSTEM:
Altered sensorium, irrelevant talking and unable to recognize his wife and He is pulling away the cannula.