A 70 year old female came to casuality with c/o fever since 1 day. Left sided chest pain since yesterday night and vomiting since today morning (1 episode) at 4 am.
She was apparently asymptomatic 1 day back and then she developed fever, lowgrade, continuos relieved on taking medication. Not associated with chills and rigors
Left sided chest pain non radiating, pricking type of sensation to the left hand, associated with sweating, heaviness to the chest and chest tightness present.
Vomitings in the morning at 4am had non projectile, non bilious, contains food particles and non foul smelling.
Past history:
In 2007 she had similar complains PTCA (LCX territory)---> triple vessel disease LCX, RCA CABG done.
In 2017 similar complaints admitted in NIMS, conservatively treated.
K/c/o diabetes and hypertension since 15 years.
Using vildaglitan 50 mg and metformin 500mg and telma 40 mg.
O: General Examination:
Patient is C/C/C
No pallor, icterus, cyanosis, clubbing, koilonychia, lymphadenopathy, edema
Vitals:
PR- 85 bpm
BP- 130/80 mmHg
RR- 14 cpm
SpO2- 100% at RA
Investigations:
Diagnosis:
DKA with anteroinferior wall MI (NSTEMI).
Treatment:
1. Inj. HAI 1 ml (40 U) + 39 ml NS at 8 ml/hr to maintain GRBS less than 200 mg/dl
2. IVF. 1 unit NS continuous infusion at urine output + 30ml/hr
3. TAB ECOSPORIN 75 MG PO OD
4. TAB CLOPIDOGREL 75 MG PO OD
5. TAB CARDIVAS 3.125 MG PO BD
6. INJ. CLEXANE 60 MG S/C BD FOR 5 DAYS
7. TAB MONIT GTN 2.6 MG PO OD.
Day 2: 6th jan
S: nausea,generalised weakness
No fever spikes
Pt complaining of chills
Bp :140/90mmhg
PR: 90bpm
RR : 18
Spo2 : 99% at room air
Pt is on insulin infusion since yesterday,
She had 2 episodes of hypoglycemia
Anion gap reduced (31.7 to 21)
Still continuing infusion at 2ml/hr
A: DKA with anterolateral wall MI(NSTEMI)
K/c/o DM and HTN
Infusion HAI 1 ml (40 U) + 39 ml NS at 8 ml/hr to maintain GRBS less than 200 mg/dl
2. IVF. 1 unit NS continuous infusion at urine output + 30ml/hr
3. TAB ECOSPORIN 75 MG PO OD
4. TAB CLOPIDOGREL 75 MG PO OD
5. TAB CARDIVAS 3.125 MG PO BD
6. INJ. CLEXANE 60 MG S/C BD FOR 5 DAYS
7. TAB MONIT GTN 2.6 MG PO OD
Investigations
Urea: 71
Creat: 2.4
Na+ : 134
K+ : 4.8
Cl- : 102
Abg at 6 am
Day 3 : 7th Jan
S: nausea reduced ,generalised weakness
One fever spike @6pm
Temp 100.6 F
O :
Bp :140/80mmhg
PR: 82bpm
RR : 18
Spo2 : 99% at room air
insulin infusion stopped,
No episodes of hypoglycemia
Input/ output: 1100/1000 ml
A: DKA with anterolateral wall MI(NSTEMI)
K/c/o DM and HTN
P: started orally
Bridging of insulin done.. Insulin dose fixed to 10units HAI s/c tid
Plan to shift to amc
1. Inj HAI 10units sc tid
2. IVF. NS continuous infusion at urine output + 30ml/hr
3. TAB ECOSPORIN 75 MG PO OD
4. TAB CLOPIDOGREL 75 MG PO OD
5. TAB CARDIVAS 3.125 MG PO BD
6. INJ. CLEXANE 60 MG S/C BD FOR 5 DAYS
7. TAB MONIT GTN 2.6 MG PO OD
8. Inj LASIX 20MG IV BD
Investigations
Na+ : 132
K- : 4.1
Cl- : 99
Abg at 6 am
Day 4
Investigations
Investigations
Day 5
Investigations
Usg abdomen report:
