1701006154 short case
Diabetic ketoacidosis with perianal abscess
I’ve been given this case to solve in an attempt to understand the topic of “patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations, and come up with diagnosis and treatment plan
S.Vikas Varma
1701006154
A 18 year old female came to casuality on 3/1/23
With chief complaints of
Sob since 2days
feversince 1 week,,
Pain and swelling in the perianal region since 10 days
HOPI: The patient was apparently asymptomatic 9 years ago
Course of events:
9 years ago:
She had polyuria,polydipsia,polyphagia weakness and weight loss due to which she visited a local hospital and there her grbs was high and was diagnosed to be having diabetes and started on insulin injection and was using since then?
Inj mixtard 20U - x- 15U.
In between due to raised sugar levels she develops abdominal pain and consults a doctor and takes fluids and high dose of insulin
1 week ago:
Patient had swelling over Analverge a which was initially 1x 1cns and progressed to the present size of 4x4 cms associated with discharge of pus and mixed with blood, associated with High grade fever associated with chills and rigor for which she consulted local doctor and prescribed antibiotics and she used for 5 days and also developed nausea due to which she was not on proper diet and so she decreased her insulin dosage to 5u - 5u on her own since 3 days and developed sob on rest since 2 days and yesterday as sob was increased and got her Grbs checked at home and it was 480mg/dl and was taken to local hospital and was given injection ( not known)and since today morning her sob was increased went to hospital and RBS being high insulin14u HAI given and referred here for further management
Past history:
H/O similar complaints of swelling in inner thighs and in gluteal region 1 year back as she has taken covid vaccine on that time and she consulted local doctor and recieved antibiotics ( amoxiclav 625mg/po/bd for 5 days and also herbal medicine for swelling local application it got relieved
Not a k/c/o hypertension, Tb,asthma, epilepsy, thyroid disorders
Menstrual history:
Age of menarche: 13 years
Menses: regular,28 days cycle
Flowincreased associated with clots and pain
Personal history:
Appetite: decreased
Diet: mixed
Bowel and bladder: regular
Sleep: adequate
Addictions: no
Family History: her father is a known case of diabetes since 16 years and he was using insulin mixtard 2 times daily
General examination:
Patient was conscious, coherent, cooperative
Pallor: present
Icterus: absent
No cyanosis, clubbing, lymphadenopathy,edema
Vitals:
Temperature: 101 F
Bp: 120/70mmhg
PR: 92 BPM
RR: Tachyponeic at the time of admission
21cpm
Spo2: 98% on ra
Grbs:
On local examination:
Swelling was in perianal region which was initially 1x1 cms and progressed to present size of 4x4 cms
Pus discharge present
Skin over swelling: reddish colour
Palpation:
Tenderness+
Local rise of temperature
Induration of skin over the swelling+
Visible pus discharge
Pictures captured by Dr lohith pgy1
After iand d of abscess picture:
On6/1/23:
On 7/1/23:
Systemic examination:
Respiratory system:
BAE-PRESENT,
Per abdomen:
Per abdomen;
CVS:
CNS:
Higher mental functions intact
USG abdomen:
Internal echoes noted in urinary bladder
? Cystitis
Chest x ray:
2d echo:
No AR /MR/TR
No RWMA,No As/ps
Good lv systolic function
No diastolic dysfunction
No pAH/pe
Diagnosis:
Diabetic ketoacidosis with Type 1 DM since 6 years with perianal abscess
S/P : incision and drainage of abscess done under spinal anaesthesia ( 3/1/23)
Treatment:
Iv fluids Ns@100ml/hr
Inj Human Actrapid insulin Sc/TID
12u- 12u- 12u
Inj NPH sc/BD
15u- × -15u
Inj meropenam 1gm/iv/Bd d2
Inj Amikacin 500 mg/iv/Bd d2
Inj metrogyl 500 mg/iv/Tid d3
Inj pan 40 mg/ iv/ bd
Inj neomol 1 gm/iv/bd
Inj Tramadol 2ampoules in 100ml Ns/iv/bd
Inj Zofer 4 mg/ iv/bd
Inj kcl 20 meq in 100 ml Ns/iv /stat
Tab orofer xt/ po/ od @2pm
Tab Dolo 650mg/po/Tid
Sitz bath/ qid
Strict I/O charting
Grbs 7 print profile
6/1/23
: No fever spikes
Stools passed
