TELE MEDICINE

 37 year old male came to casualty with SOB grade 3 since 2 days and burning micturition since 2 days .

HOPI : 

Patient was apparently asymptomatic 2 years ago , then he developed SOB (?kussmaul breathing) ,he was taken to nearby hospital where he was diagnosed to have high sugars  then patient was started on insulin infusion and was hospitalized for few days and at the time of discharge patient was put on INJ MIXTARD 20u -x-15u 

Patient was on insulin for the past 2 months switched to OHA (tab -glimi M2 ) po/bd since 3 months  

1 and 1/2 year back he had h/o cough with sputum diagnosed as Pulmonary TB and was started on ATT for 6 months 

Patient was non compliant to OHA and insulin 

Personal history : 

Diet - mixed 

Appetite - decreased 

Sleep -adequate 

Bowel and bladder habits - regular 

Betel leaf - yes 

General examination : 

Patient is conscious coherent and cooperative 

No h/o pallor ,icterus, cyanosis, clubbing, lymphadenopathy 

Temp - 98.3 degree f 

Pr -105 bpm 

RR - 35 cpm 

Bp - 140/90 mmHg 

Spo2 - 99%@Ra 

GRBS - 426 mg/dl 

Systemic examination:

CVS - S1 S2 +

Rs - breath sounds decreased in all areas 

P/a - soft ,non tender ,no organomegaly 

CNS - GCS -15/15 ,nfnd

USG 

Cue 

Urine for ketone bodies 

Hemogram

2d echo 

Insulin infusion rate and GRBS monitoring

Diagnosis : 

DKA with DM type 2 

DKA secondary to ?UTI  with severe metabolic acidosis secondary to uti 

Treatment : 

1.IVF - 20 ml/kg/hr iv stat f/b 10ml/kg/hr iv continuous 

2.Inj Pantop 80 mg in 100 ml ns 

3.Inj Actrapid 40 u in 50 ml ns @6 ml/hr 

4.inj actrapid 6 u iv stat 

5.inj Zofer 4 mg IV sos

6.inj Ceftriaxone 1gm iv bd 

7.ivf 5%d @75ml / hr