Dka

 A 29 yr old male presented to casuality with left sided chest pain since 10 days worsening since yesterday night 

 HOPI : 

 Pt was apparently asymptomatic 15 days then he developed fever after spraying pesticides in field ,associated with cough with expectoration 

Pt was taken to a local doctor and treated symptomatically , but symptoms not relieved 

Pt developed left sided chest pain 10 days back ,non radiating ,diffuse pain ,pain increased on inspiration 

 Not a/w sweating, palpitations

pt was refered to our hospital in view of persistent fever ,cough with chest pain 


PAST HISTORY : 

 No h/o HTN,epilepsy,TB,asthma 


PERSONAL HISTORY :

 Appetite -normal 

Diet mixed 

Bowel and bladder- regular 

Sleep adequate 

Addictions - 


FAMILY HISTORY 

Not significant 


GENERAL EXAMINATION 

O/E pt is c,c,c 

Moderately built

No pallor ,icterus, cyanosis, clubbing, lymphadenopathy ,edema of feet 

 

Vitals :

Temp : 

Bp :

PR: 

Rr: 

Spo2: 


RS:

Inspection : shape of chest : normal 

⁃ Symmetry of chest : symmetrical 

     ⁃ No visible scars , no sinuses , no engorged veins 

⁃ No deformities of spine 

⁃ No visible apical impulse 

Palpation:

        -No tenderness and no local rise of             temperature 

⁃ Inspectory findings are confirmed

⁃ Trachea central 

⁃ Apex beat : felt at 5 th Intercoastal space  medial to mid clavicular line

      - vocal fremitus 

Percussion :

Auscultation:

        -B/L Air entry pesent 

         -Left  side inspiratory crepts  in IMA,IAA 

       - Aegophony 


Cvs : s1 s2 heard ,no murmurs 

CNS: NAD 

PA : soft , non tender ,no organomegaly 


INVESTIGATIONS : 


  PROVISIONAL Diagnosis : DIABETIC KETOACIDOSIS WITH 

                       ? LEFT MIDDLE LOBE PNEUMONIA 

                     WITH DENOVO TYPE 1 DM 


TREATMENT 

 1) IVF-NS  @100ml /hr 

 2) INJ. HAI INFUSION @4ml/hr 

3)INJ PAN 40mg iv /od 

4)INJ ZOFER 4 mg iv/sos 

5)INJ NEOMAL 1gm iv/sos

6)TAB PCM 650mg /po/ sos 

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