A 41 year old female with diabetes, abdominal pain ,nausea and vomiting
A 41 year old female with diabetes, abdominal pain ,nausea and vomiting
A 41 year old female housewife from Miriyalguda came to casualty with C/O:
Nausea and vomiting since 3days
Abdominal pain since 3days
HISTORY OF PRESENT ILLNESS :
Patient was apparently asymptomatic 4days back then she developed nausea and vomiting, 8-10 episodes of vomiting, content food material watery, non bilious, non projectile, not blood binged and associated with Abdominal pain of diffuse type and non radiating.
No H/O chest pain, Pedal edema, burning micturition, coughing, palpitations, excessive sweating, giddiness and wheeze
H/o skipping OHAs since 2 days
HISTORY OF PAST ILLNESS:
K/c/o Diabetes Mellitus type 2 since 2 years for which she is on medication (Tab Glimi M1 )
H/o raised blood pressure.
H/o undergoing tubectomy.
No h/o addiction or allergies
DAILY ROUTINE:
Patient initially used to wake up at 5:30 am, now she wakes up at around 6 am. She has idli or dosa for breakfast around 7 am. She then does her household chores and has white rice and curry for lunch at around 1:30 pm. She then continues the house hold work or occasionally watches TV till around 7 pm then she starts preparing and has dinner (white rice/roti/howar roti) and goes to bed by around 9 pm.
GENERAL EXAMINATION
Patient is concious, coherent and cooperative
No signs of pallor, icterus, clubbing, cyanosis, lymphadenopathy, edema.
Vitals:
BP: 170/110mmhg
PR: 68bpm
RR: 16 cpm
Temp: 97.8 F
GRBS: 200 mg/dl
SPO2: 98% at RA
SYSTEMIC EXAMINATION:
RESPIRATORY SYSTEM EXAMINATION :
Bilateral air entry +
Normal vesicular breath sounds heard
Trachea central
No added sounds
CVS EXAMINATION :
S1, S2 heard
No murmurs
ABDOMEN EXAMINATION :
Soft, no tenderness
No organomegaly
Bowel sounds - present
CNS EXAMINATION :
Gcs - E4V5M6 (15/15)
Higher mental functions - normal
Cranial nerve examination - normal
Sensory and motor system normal
No signs of meningeal irritation
INVESTIGATIONS:
URINE FOR KETONE BODIES : positive
BLOOD GROUP: B positive
RANDOM BLOOD SUGAR : 200 mg/dl
HEMOGRAM :
CUE:
LFT:
SERUM OSMOLALITY:
BLOOD UREA:
SERUM CREATININE:
ABG:
CHEST X RAY: Normal
2D ECHO: Normal
ULTRASOUND ABDOMEN:
Impression: Grade 1 fatty liver
PROVISIONAL DIAGNOSIS:
41 year old female diagnosed with Diabetic ketosis with DM type 2.
