SHORT CASE( FINAL PRATICAL)

 This is an online e-log book to discuss our patient's de-identified health data shared after taking his/her/guardian's 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.

A 43year old female  patients came to causality with chief complaints of abdominal , vomiting and lower back since a day.

Patient was also diagnosed with hypothyroidism and diabetes mellitus in the past.

HISTORY OF PRESENT ILLNESS:

Patient was apparently well asymptomatic 6 years back and had developed Anasarca for which she was diagnosed in the hospital at Hyderabad with hypothyroidism .

Patient also complaints of  pain in  abdomen which is diffuse , dull aching and intermittet and associated with vomiting , 2 episodes which was non projectile and presence of food particles and non bilious.

No history of fever, cold, cough, loose stools, constipation,  malena and haematuria.

For hypothyroidism takes tab. Thyronorm .

She was also diagnosed with renal failure for which she takes inj.mixtard.

PAST HISTORY:

It is known case of diabetes and hypothyroidism .

No history of hypertension, epilepsy and asthma.

PERSONAL HISTORY : 

Diet : mixed 

Appetite : decreasd since 6 yrs 

Sleep : adequate 

Bowel & bladder : regular 

No  addictions.

DRUG ALLERGY: not associated with any allergy of known drugs.

Post menopausal since 2 years 

FAMILY HISTORY: no similar complaints.

GENERAL EXAMINATION:

Patient was coherent,cooperative,  concious and well oriented to the place.

Patient is pallor.



No cyanosis icterus clubbing and generalised lymphadenopathy.





VITAL SIGNS:

Temperature : aferible.

Pulse rate :  88beats /minutes.

BP: 150/ 80 mmHg.

Respiratory rate:21/minutes.

SYSTEMIC EXAMINATION:


Cardiovascular system:

No thrills and cardiac mummurs .

S1 and S2 are heard .

Respiratory system:

No wheezing 

Presence of dyspnoea.

Positioning of trachea is central and breath sounds are vesicular.

Abdomen:

Abdomen appear to be distented and tenderness is present .
No palpable mass is present.
 free fluid is present 
 bruits , liver and spleen are not palpable .

bowel sounds are heard .

Central nervous system:

Patient is conscious and speech is normal.No signs of meningeal irritation such as neck stiffness and kerning's sign.

Cerebral signs such as finger - nose in coordination and knee - heal incoordination are not present .
 
INVESTIGATION:
Ultrasound :



HEMOGRAM:


Complete urine examination:

Urine for ketone bodies:

Bacterial culture and sentivity:


Color Doppler 2D echo:


ECG :


PROVISIONAL DIAGNOSIS: 

DKA secondary to pain in abdominal (pancreatitis)  with DM-2, hypothyroidism, CKD , high anion gap  metabolic acidosis.

TREATMENT:

 Fluid restrictions <1.5 L / day.
Salt restrictions <2.4g/day.
Inj.optineuron 1 amp in 100 ml NS IV /OD 
Inj . Ceftriaxone 1 gm IV / BD.
INJ. PANTOP 40mg IV/OD
NJ.ZOFER 4mg IV/TID 
INJ. METROGYL 500MG /IV / TID
 INJ. TRAMADOL 1AMP IN 100 ML NS /IV/TID 
INJ. INSULIN INFUSION WITH 2ML/HR 
INJ.BUSCOPAN 2CC IV/SOS
INJ.LASIX 40MG IV/BD
 TAB.THYRONORM 50microgram PO/OD



Comments

  1. Goji Berries... yes... I tried those too.For my health conditions, Those sweet, red berries seemed to help, but only during the time when I consumed them. I don't want to take a drug for the rest of my life, so why would I want to take a natural supplement everyday for the rest of my life (although Goji berries are very tasty and are highly nourishing). To me this was not a cure either (and I'm LOOKING for the CURE).
    Up to that point, I hadn't found a cure. I felt like a young jumbled mess. I continued to have extreme pain, but continued on my path to healing. I started to focus on myself and not everyone else. When I was a young adult, I took on too much responsibility out of a sense of obligation. This was no longer healthy for me, so I resigned from all my projects and groups. Those days to come were the best [and worst] days. I took a lot of time off work, yet began to feel so extremely exhausted. Many health professionals "diagnosed" me with adrenal fatigue & Hiv,Prostate Cancer so my situation was annoying then I keep searching for permanent cure online that's when I came to know of Dr Itua herbal center hands whom god has blessed with ancestral herbs and a gift to heal people with diseaseSo I made a purchase of his herbal medicines and I have been watching my health for 6 years now and I actually confirmed that his herbal medicines are a permanent cure and I'm so happy that I came to know of his herbal healings.You can contact Dr Itua herbal center Email: drituaherbalcenter@gmail.com www.drituaherbalcenter.com if you went through exactly what I go through in terms of health conditions because to be honest there is more to learn about natural herbs than medical drugs.

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