CASE PRESENTATION ON

DIABETIC KETOACIDOSIS;ACUTE
KIDNEY INJURY;SEPTIC SHOCK

B.MEGHAN
A
Y16PHD0804

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ABOUT DISEASE:

DIABETIC KETOACIDOSIS:Diabetic ketoacidosis (DKA) is a serious

complication of type 1 diabetes and, much less commonly, of type 2
diabetes. DKA happens when your blood sugar is very high and acidic
substances called ketones build up to dangerous levels in your body.

 SEPTIC SHOCK:
Sepsis is the result of an infection, and causes drastic changes in the body.
It can be very dangerous and potentially life-threatening.
It occurs when chemicals that fight infection by triggering inflammatory
reactions are released into the bloodstream.

PSORIASIS:
Psoriasis is a skin disorder that causes skin cells to multiply up to 10 times
faster than normal. This makes the skin build up into bumpy red patches
covered with white scales. They can grow anywhere, but most appear on
the scalp, elbows, knees, and lower back.
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 DEMOGRAPHICS

NAME OF THE PATIENT:M.PRASANNA

AGE:38YRS
GENDER:FEMALE
D.O.A:CH.MANOJ KUMAR
HOSP.NO:5629898
WT:90KG

Chief complaints: Altered sensorium

Generalized weakness
Irrelevant talk
Pain abdomen;Nausea
Skin allergy; loose of appettite
Joint pain

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PAST HISTORY: K/C/O T2 DM-2yrs
Hyperthyroid:2month
Rheumatoid arthritis
H/O laproscopy 20yrs back
MEDICATION HISTORY: Not on regular medication.
PERSONAL HISTORY: Sleep –normal
appetite-normal

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PHYSICAL EXAMINATION:
Vital 8/12 9/12 10/12 11/12 12/12 14/12 15/12
signs
B.p 110/60 100/60 110/70 110/70 100/60 130/80 120/70
P.R 87 112 114 95 111 84 82
R.R 18/min 16/min 18/min 18/min 23/min 22/min 22/min

SPO2 100% 100% 100% 97% 99% 97% 98%

SYSTEMIC EXAMINATION:

CVS:S1-S2
RS:BAE(+)
P/A-SOFT
GRBS:HIGH
ON EXAMINATION: CRUSTING(+);SKIN RASHES(+)
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 SUBJECTIVE EVIDENCE
 Altered sensorium
 Generalized weakness
 Irrelevant talk
 Pain abdomen; Nausea
 (burning sensation)Skin allergy; loose of apettite
 Joint pain

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 OBJECTIVE EVIDENCE
Lab Reports:
8/12: 9/12 12/2
Sr.creatitine-2.80( ) 2.00 0.40
Bun:43.00 ( )
Sr.Na:128.0 118.0 150
Uric acid:9.9mg/dl ( )
Sr k(+)-8.1mmol ( ) 8.1mmol/l 2.6
Sr.cl-87.3 ( ) 108.6mmol/l
HbA1c:8.7% ( )
R.B.C:3.56 ( )
Hb:9.5g/dl ( ) 11.4g/dl
MCV-100.2fl ( )
MCH:26.7pg ( )
MCHC:26.6g/dl ( )
RDW:17.5 % ( )
ESR:52 ( )
W.B.C:17900/CU ( ) 18800 3700

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Procalcitonin:1.100ng/ml( )
C reactive protein:42.52mg/dl( +ve )
Sr.glucose:740mg/dl( )
Bilirubin indirect:0.06mg/dl( )
SGOT:44 IU/L( )
ALP:112 IU/L( )
Sr.Albumin:3.4g/dl( )
T3-0.5ng/ml( )
TSH:0.274micu/ml( )
Cortisol plasma:36.80micro gram( )
ACTH:1.00<pg/ml( )

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Urine analysis:
Apperenace: slightly turbid
Glucose(+)
R.B.C:4-6
Epithelial cell:4-6
Ketone bodies(+Ve)
PLAIN CT SCAN OF CHEST:
Impression: calcified granuloma 5mm in rt middle lobe.tiny 3mm
nodule in rt upper lobe abuting the major fissure.
Few calcified para tracheal and pervascular lymphnode;largest
measuring 17*14mm-sequeale of previous infections.

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 ASSESSEMENT
Based on the subjective and objective patient was
diagnosed as PSORIASIS; ACUTE KIDNEY INJURY;
SEPTIC SHOCK; DIABETIC
KETOACIDOSIS;STEVEN JHONSON SYNDROME.

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 PLANNING
S.N BRAND NAME DOS R.O. FREQ STRAT STOP DATE
O E A DATE

1. Inj.Targold 400m I.V OD 8/12 13/12 STOP

g
2. Inj.Pantociid 40mg I.v OD 8/12 13/12
3. Inj.vit-C 1.5g I.V BD 8/12 14/12
4. Inj.Glutabest 50ml I.V BD 8/12 14/12
5. Dermadew aleo BD 8/12 15/12
vera
6. Clonate ointment OD 8/12 14/12
7. Cap.H.H.Omega 1 cap p/o OD 8/12 14/12
8. Inj.Hydrocortisone 50mg I.V TID 8/12 14/12
9. T. Ivabrad 5mg I.V BD 11/12 15/12
10. Neb.Duolin 1amp P/N 8th 11/12 15/12
Hourly
11. Neb.Budecort 1 amp P/N 12th 11/12 15/12
hourly
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S.NO BRAND DOSE R.O.A FREQ STRAT STOP
NAME DATE DATE
12. T.predmet 8mg po OD 14/12 15/12
13. T.Monetek lc 1tab po hs 14/12
14. T.Limcee R/T OD 8/12

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LIFE STYLE MODIFICATION:

•Taking two and a half hours each week of moderate intensity physical
activity or one hour and 15 minutes of high intensity exercise.
NICE recommend taking either 2 ½ hours of moderate intensity
physical activity or 1 ¼ hours of intense exercise.
•Brisk walking
•Cycling on relatively flat terrain
•Water aerobics
•Hiking
•Rollerblading
•Using a manual lawnmower
•Losing weight gradually to achieve a healthy body mass index
•Replacing refined carbohydrates with wholegrain foods and increase
intake of vegetables and other foods high in dietary fibre
•Reducing the amount of saturated fat in the diet

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Fat intake
The advice on fat is to reduce overall fat intake, and particularly to reduce
intake of saturated fat as found in chips, crisps, pastries, biscuits and
samosas.
Lean meats
Choosing lean meats, such as skinless chicken and turkey helps to cut
down on saturated fat. It is recommended to eat less processed meats.
Grilling and steaming food will cut down on fat intake in comparison with
cooking methods involving frying or roasting.
Portion sizes
Reducing portion sizes will also help to lower calorie intake. The Diet
Plate is an excellent solution if you are looking to control your calorie
intake.

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THANK U
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