A 21 YEAR OLD MALE WITH FEVER,VOMITING AND LOSS OF APPETITE.

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment"

A 21 YEAR OLD MALE WITH FEVER, VOMITING AND LOSS OF APPETITE.


A 21year old male came to casualty with chief complaints of decreased appetite since 7days,c/o fever since 5 days,c/o vomiting since 1day,c/o sob since morning.

Patient was apparently asymptomatic 5days back then he developed fever which is of incidious in onset, intermittent and is of high grade fever,a/w chills and relieved on medication. Pt has H/o 1episode of vomiting 1day back which is non bilious,non projectile.
No h/o any burning micturition,throat pain,cold,cough.

PAST HISTORY:
Not a k/c/o HTN,DM, CAD, asthma, TB, epilepsy.


PERSONAL HISTORY:
Patient has mixed diet with normal appetite and adequate sleep. 
he has normal bowel movements and bladder filling. 
No addictions. 

No significant family history or allergic history. 

GENERAL EXAMNATION:
Patient is c/c/c with moderate built and moderate nourishment. 
No pallor, icterus, cyanosis, clubbing, lymphadenopathy, pedal edema. 
VITALS:
BP: 140/90 MMHG, 
PR: 120bpm 
Temp: 98.2°F, 
RR: 40 CPM, 
SPO2: 99% 

RS: BAE+,NVBS

CVS: S1 ans S2 heard. No murmurs. 
P/A: soft and non-tender. 
CNS: No focal deformities. 

INVESTIGATIONS:
1) HEMOGRAM : 
Hb: 8.2
TLC: 15800
N:89
L:6
PCV: 30
Mcv:63.7
MCH:17.4
MCHC:27.3
PLC:3.37
RBC:4.71

2) LFT:
TB: 0.74
DB: 0.17
SGOT: 10
SGPT: 12
AP: 137
TP: 5.8
A: 24
A/G: 0.72

3)CUE
Alb:nill
Sug:nill
Ec:3-4
Pc:2-3
RBC:nill



4)BLOOD UREA:29

 5)RBS:194
6)ABG@2PM
Ph-7.09
Pco2--144
Po2-144
Hco3-1.7
St.hco3-5.5
O2 stat-95
AG-36

7) urine for ketone bodies- positive.

8)serum electrolytes
On admission at 2 pm ,Na+ 143,K+4.1,Cl- 105
At 10 pm,Na+ 137,K+ 3.2,Cl-101
On 2/10/21,@8:00 am ,Na+ 135,K+ 3.3,Cl- 98

9) serum creatinine-0.8

10) ecg-

11) CXR-





PROVISIONAL DIAGNOSIS:DIABETIC KETOACIDOSIS WITH DENOVO DETECTED DIABETES WITH VIRAL PYREXIA UNDER EVALUATION.

TREATMENT GIVEN-
-NBM TILL FURTHER ORDERS.
-IV FLUIDS- 3 L NS @ 500 ml / hr in 3 hrs followed by IV fluid ns @250 ml / hr.
-Inj.HAI 4 IU IV stat followed by Inj .HAI 1 ml (40 IU) in 49 ml NS  @ 4 ml/ hr until abg correction.
-Inj.pan 40 mg IV od
-IVF 5% dextrose @ 50-100 ml/ hr When grbs less than 150(to be decreased or increased according to grbs)
-Inj.optineuron 1 amp in 100 ml NS IV od
-Inj.kcl 2amp in 500 ml NS @ 100 ml / hr
-Grbs monitoring hourly
-Strict i/o monitoring
-Inform sos.

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