52 year old female with uncontrolled sugars

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 52 year old female who is a farmer came to the casuality with complaints of 

Shortness of breath since afternoon 

Vomitings since afternoon

Pain abdomen since afternoon

Dyspepsia since afternoon

HISTORY OF PRESENT ILLNESS :

Patient was apparently asymptomatic shortness of breath  since afternoon( grade 2 to grade 3 ) according to NYHA classification 

C/o vomitings ( 3 episodes food particle as content) , non bilious, non projectile 

C/o pain abdomen ( diffuse type) associated with loose stools  ( 2 episodes ) non blood typed , non foul smelling 

C/o dyspepsia since afternoon

PAST HISTORY : 

Similar complaints in the past ( was admitted in our hospital and treated 9 months back ) 

K/c/o DM  since 4 years on insulin (HAI -17 U -x-10U)

N/ k / c /o  HTN , Asthma , epilepsy , TB 

On examination : 

Patient is consious , coherent and cooperative

Bp:120/60mm hg 

PR ; 112 bpm  regular

RR :30 / min

Cvs : s1 s2 +

Rs : BAE +

P/A: soft , non tender 

PROVISIONAL DIAGNOSIS: 

Diabetic ketoacidosis secondary to GE 

Investigations : 

19/3/22

Urine for ketone bodies positive 

                    10pm     1 am     5 am

PH                6.94.      7.25      7.35

PCO2           9.2          19.9       27.8

PO2              125          87          72.9

HCO3            1.9          8.6         15

St HCO3        5.2         12.3        17.4

                   20/3/22     21/3/22

PH                7.36          7.36

PCO2            27.5          31.0

PO2              80.6           79.5

HCO3           15.2           17.2

St HCO3        17.5          19.2

21/3/22

TREATMENT: 

I. Inj HAI 6 U / IV /stat to Inj.HAI 40 IU in 39ml NS/IV/once 6 ml/hr

2.IVF - ns and rl @ 125 ml/ hr

3.inj pantop 40mg /IV /OD 

4.inj zofer 4mg/iv/od