Case of a 60 years old man with diabetes ketoacidosis.

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This is a case of a 60-years-old man, working as a cook in a hotel and residing at Nakrekal.

CHIEF COMPLAINT

The patient presented to the casualty with altered sensorium and confusion.

HISTORY OF PRESENTING ILLNESS

The patient was apparently asymptomatic, 12 years ago. He had an episode of giddiness and weakness 12 years ago, for which he went to the hospital and was diagnosed with type II diabetes mellitus. Since then he has been on medication, with progressively increasing dosage over the years.

For 3 years the patient has been taking insulin injections .4 months ago, the patient underwent surgical amputation of three toes of left foot, due to the development of gangrene. The patient has been unemployed since then.

5 days ago the patient had a fever.

4 days ago, on the day of admission, the patient consumed a large amount of alcohol and had a heavy meal with mutton. He also forgot to take his evening medication. Since then the patient had abnormal behaviour.

HISTORY OF PAST ILLNESS

The patient was diagnosed with type II diabetes mellitus  12 years ago.

He has no history of HTN, asthma, epilepsy, or TB.

FAMILY HISTORY

 1 sibling (brother) also has diabetes mellitus.

PERSONAL HISTORY

Diet-Mixed

Sleep- adequate-

Bowel and bladder movements - Normal

Addictions - 

The patient is a regular consumer of alcohol.

12 years ago - the patient used to consume 1-2 quarters of alcohol.

After he got diagnosed with diabetes - His intake reduced ( 1quarter a day)

He stopped consuming completely for the last 4 months. 

On the day of admission consumed alcohol in large amounts.

Smoking - NO

EXAMINATION

GENERAL EXAMINATION 

Pallor-mild 

Icterus-absent

Clubbing-absent

Cyanosis-absent

Lymphadenopathy-absent

Edema-absent

SYSTEMIC EXAMINATION

CVS

S1 , S2 heard
No thrills 
No murmurs

RESPIRATORY
Normal vesicular breath sounds heard
No wheeze or crepitations
Central position of the trachea

ABDOMEN
Obese abdomen
No tenderness
No hepatosplenomegaly

CNS
The patient is coherent, cooperative and oriented to time and place.
No neck stiffness 
Kernig's sign- negative

INVESTIGATIONS(on the day of admission)

Fever chart

CBP

CUE

LFT

RFT

PROVISIONAL DIAGNOSIS

Diabetes ketoacidosis

Delirium secondary to diabetes ketoacidosis

TREATMENT

IVF-NS @ 100 ml/hr

Inj Thiamine 1 amp in 100ml NS/IV/OD

Inj Zofer 4 mg /IV/SOS

Inj Monocef 1g/IV/BD

Tab Quetiapine 25 mg

Inj Lorazepam 1/2 amp IV/SOS

Inj HAI S/C acc to GRBS

GRBS monitoring 7-1-7-10

Oint thrombophobe for L/A

Oint T-Bact for LA.