A 50 year old female came with 

C/o fever and vomitings (4episodes/day) since 1 week

HOPI:

Patient was apparently asymptomatic 1 week ago then she developed fever of low grade with chills and rigors, intermittent associated with vomitings of 4 episodes/day since 1 week, non projectile, non bilious, contains food particles as content.

Past History:

K/c/o DM2 since 20 years( using metformin 500mg PO/OD)

K/c/o HTN since 20 years(using telmikind 40mg PO/OD) stopped using since 3 days

N/k/c/o Asthma, CAD, TV, Epilepsy 

O/E:

Vitals

Temp: Afebrile

BP: 150/70mmhg

PR:96bpm

CVS: S1S2 +

RS: NVBS +

CNS: NAD

GRBS: HI —— HI——397mg/dl

Clinical Images-







Provisional Diagnosis:

Diabetic Ketoacidosis secondary to non compliance with AKI (Renal) on CKD. K/c/o DM2 since 20 years, K/c/o HTN since 20 years , k/c/o CVA 2 months ago( left hemiparesis) with hyperkalaemia with HFmEF(44%) with Dilated Cardiomyopathy


Treatment:

Inj. Piptaz 2.25gm IV/ TID

Inj. Pantop 40mg IV/OD

Inj.Neomol 1gm IV/SOS 

Inj. Lasix 40mge IV/BD

Inj. HAI S/c TID

Inj. Zofer 4mg IV/SOS 

Tab.Exospirin AV (75/10) PO/HS

Tab.PCM PO/SOS

Syp Lactulose 10ml PO/BD

IV fluids NS 50ml/hr

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