A 14 year old with shortness of breath since 2 days

 This is a case of a 14 year old girl who came with chief complaints of:



Shortness of breath since 2 days



Fever since 1 day



Abdominal pain since 1 day



Vomiting 1 episode



HOPI: 



The patient was apparently asymptomatic 4 years ago, then she had a fever with generalised body weakness and polyuria and was diagnosed having type 1 DM and started on insulin.



2 years ago patient had similar complaints after an episode of fever and was admitted at our hospital and was treated here. 



 2 days ago then she developed sudden onset shortness of breath since 2 days, gradually progressive and progressed to stage 4. Shortness of breath started after patient missed taking 2 doses of insulin. No orthopnea, no PND. 



Fever since 1 day, high grade associated with chills and rigors, relieved on taking medication, no diurnal variation.



Abdominal pain since 1 day epigastric region alter progressed to diffuse abdominal pain.



No h/o vomiting, loose stools, giddiness.



Headache present, vomiting 1 episode- non bilious, non projectile, not blood stained, content- food material.




Past history 



k/c/o type 1 DM since 4 years in biphasic insulin 30/70(17U-12U)



h/o 2 previous admissions for fever in last 4 years




Family history



h/o diabetes in younger sister from 6 years of age




Personal history



She's a 9th class student



Diet mixed



Appetite normal



Sleep adequate



Bowel and bladder regular



Menarche not attained



GENERAL EXAMINATION



Patient is conscious coherent and cooperative. Well oriented to time place and person. 



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



Vitals:



Pulse - 98 bpm



BP - 120/80 mm Hg



RR - 28 count



Temp- 99.1F



SpO2- 98%



GRBS- 526mg%





CVS:

Inspection:


There are no chest wall abnormalities 

The position of the trachea is central. 

Apical impulse is not observed. 

There are no other visible pulsations, dilated and engorged veins, surgical scars or sinuses. 

Palpation:

Apex beat was localised in the 5th intercostal space 2cm lateral to the mid clavicular line 

Position of trachea was central 

There we no parasternal heave , thrills, tender points. 

Auscultation: 

S1 and S2 were heard 

There were no added sounds / murmurs. 

Respiratory system:

Bilateral air entry is present 

Normal vesicular breath sounds are heard. 

Per Abdomen:

Shape is scaphoid

Abdomen is soft and non tender with no signs of organomegaly

Bowel sounds are heard

CNS:

Normal

Memory intact

CRANIAL NERVES :Normal

SENSORY EXAMINATION

Normal sensations felt in all dermatomes

MOTOR EXAMINATION

Normal tone in upper and lower limb

Normal power in upper and lower limb

Normal gait

REFLEXES

Normal, brisk reflexes elicited- biceps, triceps, knee and ankle reflexes elicited

CEREBELLAR FUNCTION

Normal function

No meningeal signs were elicited


PROVISIONAL DIAGNOSIS 

Diabetic ketoacidosis secondary to non compliance

k/c/o DM1 since 4 years.




FINAL DIAGNOSIS:

DIABETIC KETOACIDOSIS secondary to non-compliance.

Comments

Post a Comment

Popular posts from this blog

A 80 year old male with left upper lobe pneumonia (CAP)with hypertension and hematemesis

Image
Patient came to OPD with complaints of SOB since 3  days and abdominal distension since 3 days (prior to admission). HOPI: Patient was apparently asymptomatic 3 days back (prior to admission),then he developed breathlessness (Grade -3 acc to NYHA ),which is sudden in onset,aggravated on supine position, orthopnea present ,PND present. H/O cough with sputum,blood stained ,moderate quantity. H/O low grade fever ,diurnal variation present ,more during night associated with sweating,no h/o cold. H/O chest heaviness ,non radiating and now relieved. H/O B/L Pedal edema upto ankles since 3-4 years,relieves on activity. H/O abdominal distension since 3 days ,insidious in onset and gradually progressive. NO H/O pain abdomen, loose stools ,constipation, regurgitation. H/O burning micturition present and dribbling of urine present H/O urge continence,no h/o stress incontinence. PAST HISTORY: k/c/o hypertension 4 years back ,on regular medication (unknown) N/k/c/o diabetes mellitus, CVA
Read more

A 55 year old patient with giddiness and vomitings

Image
      A 55 year-old female patient ,who is a homemaker by occupation and resident of AP.Lingotam presented with ,   C/O giddiness and vomitings at yesterday after 4pm. HISTORY OF PRESENTING ILLNESS: Patient was apparently asymptomatic yesterday morning (27-07-22),and then later in the evening ,while eating she had an episode of vomiting and then she felt giddy and lost her consciousness ,followed by 2 more episodes of vomitings and slurring of speech.Immediately she was taken to the local hospital and then her blood pressure was 170/90 .She was referred here .The patient was brought here by 7pm. Not associated with fever, PAST HISTORY : No similar complaints in the past. No h/oDM,HTN,ASTHMA,EPILEPSY,CAD,LEPROSY Patient has joint pains from past 15 years.Pain is of pricking type  PERSONAL HISTORY : Diet : Mixed Appetite : Good Bowel &Bladder : Regular Sleep : Adequate  Addictions :none FAMILY HISTORY : No member of family has similar complaints  MENSTRUAL HISTORY :  Patient attained
Read more

A 38 year old with shortness of breath since 20 days

Image
 A 38 year old female who is a resident of meerpet and shopkeeper by occupation came to the OPD with, C/O  Shortness of breath since 20 days          Fever since 15 days HISTORY OF PRESENTING ILLNESS:         Patient was apparently asymptomatic 2 months back, then she developed cough which is insidious in onset and gradually progressive, associated with sputum,mucoid type,non foul smelling and non blood stained and with one spoon full quantity sputum for each episode.cough worsens at night .cough associated with chest pain and chest tightening and during cough she was unable to catch her breath and after about 10-15 min she regains normal ,aggravated on cold exposure and relieved on mediaction After 5-6 days she was unable to hold the symptoms ,for that she went for hospital ,they ran some tests according to her symptoms and they diagnosed her with starting stage of pulmonary tuberculosis and treated her with medication and she is on medication from that day to 20 days span .She felt t
Read more