18 YEAR OLD MALE WITH UNCONTROLLED SUGARS

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18 year old male residing at Mungodu (nalgonda) came with c/o weight loss and unable to gain weight since 1year

HISTORY OF PRESENT ILLNESS :

Patient was apparently asymptomatic 1 year back and his sister noticed that he started loosing weight approximately 5-8kg in a duration of a year and not able to gain weight in spite of taking food regularly. 

- c/o increased appetite (polyphagia 6-8 meals per day) since 1 year 

- c/o polyuria (2-3 times overnight) 

- No h/o fever, cough, cold

- No h/o bleeding manifestations, dark coloured stools

- No h/o palpitations, sob, pedal edema

His parents both are stone cutters since his childhood. He used to go along with their parents and used to help them. 

PAST HISTORY :

- H/O ? Febrile seizures @ 2 years

- No h/o similar complaints in the past

- No h/o DM, HTN, TB, asthma

FAMILY HISTORY :

No h/o DM, HTN, TB, asthma and epilepsy 

BIRTH HISTORY :

Full term normal vaginal delivery

H/o consanguinity + 

DEVELOPMENTAL HISTORY :

Delayed milestones 

Walking at the age of 3 years

PERSONAL HISTORY :

Diet - mixed

Appetite - increased

Sleep - adequate

Bowel and bladder movements - regular 

DIETARY HISTORY :

- Early morning - glass of tea

- Morning for breakfast - rice + cup of curry 

- Lunch - rice 2-3 cups + 2 cups of curry

- Dinner - rice 2-3 cups + 2 cups of curry 

- In between these meals he also consumes same amount of food with 1-2 cups of curry every 2-3 hrly

- He consumes routinely dal(mostly) also leaf curries, brinjal etc

- He doesn't consume eggs as he don't like them

- Meat ( chicken 1 cup) once in a while of 1-2 months

GENERAL EXAMINATION :

- Patient is conscious, coherent 

- No pallor, icterus, cyanosis, clubbing, lymphadenopathy and pedal edema 

VITALS : 

Temp - 98.3 F

PR - 98 bpm

RR - 18 cpm

BP - 100/80 mm Hg

Spo2 - 98% @ room air

GRBS - >450 mg/dl

SYSTEMIC EXAMINATION :

CVS - S1S2 +

RS - BAE+

P/A - soft, nontender

CNS - NAD

Higher motor functions - intact

INVESTIGATIONS :

RBS :

ABG :

URINE FOR KETONE BODIES :

ECG :

USG ABDOMEN AND PELVIS :

BLOOD UREA :

LIVER FUNCTION TEST (LFT) :

SERUM CREATININE :

SERUM ELECTROLYTES :

HEMOGRAM :

CUE :

THYROID PROFILE:

CHEST X RAY PA VIEW :

SEROLOGY : NEGATIVE 

DIAGNOSIS : 

UNCONTROLLED SUGARS WITH DENOVO DETECTED TYPE 1 DIABETES MELLITUS

PLAN OF CARE :

1. IVF - NS, RL @ 100ML/HR

2. INJ HAI ACC. INFUSION CHARTING

3. HOURLY GRBS CHARTING 

4. INJ HAI 6U IV/STAT ACCORDING TO SLIDING SCALE

5. INJ ZOFER 4MG IV SOS

6. STRICT I/O CHARTING