Diabetic ketoacidosis with acute on chronic pancreatitis

 29yr male presented to the casuality with the chief complaints of 

 Pain abdomen since oneday 
Vomitings since one day

He waa apparently asymptomatic 2yrs ago.. Then he developed pain abdomen for which he visited local hospital and received medication.. At that time only, he was told to have diabetes and he is on regular medication (Met -500) snice then he is having on and off symptoms every 2-3 months and received medication for 3days.   .
On friday, (18/06/2021) he attended a function where he had spicy food and alcohol,  then developed pain abdomen  in the epigastric region progressive along with vomitings non projectile non bilious. For which he visited local hospital and was told to have ketone bodies in the urine.  They referred to kims narketpally

Past history :
 K/c/o DM ( on medication) 
Not ak/c/o HTN,  EPILEPSY, TB, ASTHMA  CVD
Family history :
Not significant 
Personal history :
Mixed diet
Appetite normal
Sleep adequate
He consumes alcohol every 2-3 days, 180ml, whisky since 10yrs
Smoking cigarettes. (5) during time of alcohol consumption since 10yrs. 
No known allergies 

General EXAMINATION :
PT is conscious, coherent, cooperative, well oriented to time place and person
no pallor 
No icterus
No cyanosis
No clubbing
No pedal edema
No generalised lymphadenopathy

Vitals : 
BP 130/90
PR 126bpm
temp: AFEBRILE 
SpO2 98%
GRBS 484

Systemic Examination :
 
CVS:
S1 S2 HEARD
 No murmurs. 
RESP:
BAE +
NVBS +
No adventitious sounds
Per abdomen:
Distended abdomen
Tender 
bowel sounds heard

CNS
intact

Provisional diagnosis :
Diabetic ketoacidosis with acute  on chronic pancreatitis 
Investigations :


Treatement 
19/06/2021:


NBM TILL FURTHER ORDERS
IVF- 1 NS BOLUS 3L WITHIN 1 HR OF ADMISSION
IVF NS @250 ML PER HOUR
INJ.HAI 8U IV STAT FOLLOWED BY  INJ HAI 1 ML IN 39 ML NS @ 8 ML PER hr IV infusion
GRBS MONITORING HOURLY
STRICT I/O MONITORING 
INJ.THIAMINE 200MG IN 100 NS /IV
INJ.OPTINEURON 1 AMP IN 100 ML NS /IV OVER 15 MIN 
INJ.ZOFER 4MG IV/SOS
NJ PAN 40 MG IV /OD
 

20/06/21



IVF. 1 NS ,1 RL @150 ML PER HOUR
NBM TILL FURTHER ORDERS
INJ HAI 1 ML IN 39 ML NS @6ML PER HOUR/IV/INFUSION
INJ.THIAMINE 100 MG IN 100 ML NS /IV/BD
INJ.  OPTINEURON 1 AMP IN 100 ML NS /IV/ OD
INJ.ZOFER 4MG IV/SOS
 NJ PAN 40 MG IV /OD
INJ TRAMADOL 1 AMP IN 100 ML NS/IV/SOS
STRICT I/O MONITORING 
GRBS MONITORING HOURLY

21/06/2021:

(COMPLAINTS OF ABDOMINAL TIGHTNESS ,PASSED STOOOS SEMI SOLID  ABOUT 5-6 TIMES)
BP: 120/90
PR 96 BPM
P/A SOFT 




  Rx:
IVF. 1 NS ,1 RL @150 ML PER HOUR
NBM TILL FURTHER ORDERS
INJ HAI 1 ML IN 39 ML NS @6ML PER HOUR/IV/INFUSION
INJ.THIAMINE 100 MG IN 100 ML NS /IV/BD
INJ.  OPTINEURON 1 AMP IN 100 ML NS /IV/ OD
INJ.ZOFER 4MG IV/SOS
 NJ PAN 40 MG IV /OD
INJ TRAMADOL 1 AMP IN 100 ML NS/IV/SOS
STRICT I/O MONITORING 
GRBS MONITORING HOURLY
 IV FLUID 5%DEXTROSE @50 ML PER HOUR 
 

22/06/2021:
No fresh complaints 

BP 130/80 mmHg
PR 86 bpm
GRBS 154 mg/dl
P/A : soft, non tender

Rx :
Soft oral diet
IVF 1 NS, 1 RL @ 100ml per hour 
INJ. HAI 1ML IN 39ML NS @2ML PER HOUR IV INFUSION

IVF. 5% DEXTROSE @50ML PER HOUR
INI. THIAMINE 1AMP IN 100ML ND /IV/BD
INJ. OPTINEURON 1AMP IN 100ML NS/IV/OD
INJ. ZOFER 4MG /IV/SOS
INJ. TRAMADOL 1AMP IN 100ML NS/IV/OVER 30MIN SOS
STRICT I/O MONITORING 
STRICT GRBS CHARTING HOURLY

23/06/2021
Soft oral dietIVF 1 NS, 1 RL @
100ml per hour INJ. HAI 1ML IN 39ML NS @2ML PER HOUR IV INFUSIONIVF. 5% DEXTROSE
@50ML PER HOURINI. THIAMINE 1AMP IN 100ML ND /IV/BDINJ. OPTINEURON 1AMP IN 100ML
NS/IV/ODINJ. ZOFER 4MG /IV/SOSINJ. TRAMADOL 1AMP IN 100ML NS/IV/OVER 30MIN
SOSSTRICT I/O MONITORING STRICT GRBS CHARTING HOURLYON 

24/06/2021

Soft oral
dietIVF 1 NS, 1 RL @ 100ml per hour INJ. HAI 1ML IN 39ML NS @2ML PER HOUR IV
INFUSION IVF. @50 ML PER hour
6ML PER HOURINI. THIAMINE 1AMP IN 100ML ND /IV/BDINJ. OPTINEURON 1AMP IN 100ML
NS/IV/ODINJ. ZOFER 4MG /IV/SOSINJ. TRAMADOL 1AMP IN 100ML NS/IV/OVER 30MIN
SOSSTRICT I/O MONITORING STRICT GRBS CHARTING HOURLY

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