38 year old male with DKA

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This is a case of 38 yr old male, daily wage worker,diabetic since 1 1/2 year presented to the op with the chief complaints of 

1)Sob Grade 4 since yesterday 

2) Vomitings since yesterday 


The patient is apparently asymptotic 3 days ago 

3 days back (Saturday night)

He had binge of alcohol 2 quarters 


2 days back (Sunday)

Insulin shot missed 

Afternoon had an episode of vomiting after eating food 

Vomiting was non bilious, non foul smelling non blood stained contained food particles 

Alcohol binge of 1quarter in the night 


1 days back (Monday)

Missed insulin shot 


Tuesday 

Missed insulin shot

Afternoon He had 

1)stomach pain 

2)Vomitings of 4 episodes, watery in consistency non bilious non foul smelling non blood stained 


Evening he had 

SOB of grade 4 for which he went to the local hospital where he was given medication and sent back home 

Midnight 

1)SOB grade 4

2)Vomitings of 4 episodes non bilious non foul smelling non projectile non blood stained watery in consistency 


Then he was brought to our hospital 

On presentation 

Vitals

Temp-93.7

BP-90/60

Pr-100bpm

RR-28cpm

GRBS-High (non recordable)

Spo2 96%



PAST HISTORY 

Diabetic since 1 1/2 year 

On insulin 15 units 


PERSONAL HISTORY 

Diet -mixed 

Apetite -normal 

Bowel and bladder movements - regular 

Sleep- adequate 

Addictions - 

Alcoholic since 4-5 years

Beedi smoker of 5-6 per day since 4-5 years 


FAMILY HISTORY 

Insignificant 


GENERAL EXAMINATION 

The patient is conscious coherent cooperative well oriented to time place and person 

He is moderately built and nourished 

PALLOR -absent 

ICTERUS-absent 

CYANOSIS -absent 

CLUBBING -absent 

EDEMA -absent 

LYMPHADENOPATHY -absent 


Vitals @10am Tuesday 

Temp 98.2

BP 100/60

Pr 111

RR 40

Spo2 95%

GRBS 519 6ml/hr HAI


Systemic examination 

CVS s1 s2 +

RS BAE+

CNS higher mental functions intact 

PA Soft and non tender 


Diagnosis 

Diabetic ketoacidosis 


Investigations 

HIV negative 

Hbsag negative 

HCV negative 


URINE FOR KETONE BODIES Positive 







At 4:00 Pm 


8/9/2022









Treatment 

1.IV fluids 1NS,1RS,5%dextrose @100ml/hr

2.INJ  HAI 1ml in 39ml NS infusion according sliding levels

3.INJ PAN 40mg /IV/OD/BBF














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