Case 11 A case of diabetic ketoacidosis and nausea, vomiting with bilateral upper and lower limb edema and facial puffiness in a 55 year old female patient
A case of diabetic ketoacidosis and nausea, vomiting with bilateral upper and lower limb edema and facial puffiness in a 55 year old female patient.
Case Scenario
A 55 year old woman from Nalgonda came to OPD on 3rd of June with chief complaints of:
- bilateral upper and lower limb edema since 10 days
- nausea since 1 week.
History of Presenting Illness
- patient was apparently asymptomatic 10 days ago when she developed edema in bilateral upper and lower limbs and facial puffiness for which she consulted a local physician and was prescribed medication following which the symptoms subsidised but relapsed again 1 week ago.
- since 1 week ago she has been experiencing nausea and dysphagia associated with 1 episode of vomiting after consumption of food which was non-projectile, non-bilious, having food contents.
- h/o SOB Grade 4 since 6 months
- h/o rashes on skin 1 month ago which subsidised spontaneously
- h/o burning micturition
- no h/o fever, diarrhea, constipation, melena, bleeding, hematemesis.
Past History
- k/c/o HTN since 5 years on regular medication
- diabetic on examination
- n/k/c/o tuberculosis, CAD, epilepsy, asthma, thyroid disorder
- h/o abdominal surgery for mass 30 years ago
- no h/o blood transfusions
Personal History
- married
- used to work as a housemaid before
- mixed diet
- reduced appetite
- inadequate sleep
- regular bowels
- burning micturition
- no known allergies
- alcohol and tobacco addiction 35 years ago
- analgesic abuse since 1 year
Family History
- patients mother had breast cancer
- patients brother had MI
- no diabetes mellitus
- no hypertension
- no stroke
- no tuberculosis
- no asthma
- no other hereditary diseases
Drug History
General Examination
- patient was conscious, coherent and cooperative
- well oriented to time and space
- well built and adequately nourished
- no pallor
- no icterus
- no cyanosis
- no clubbing of fingers
- no lymphadenopathy
- no pedal edema
- bilateral upper limb edema and facial puffiness present
- no malnutrition
- no dehydration
Vitals
03/06/23
- BP: 130/90 mm Hg
- Pulse rate: 108 bpm
- Respiratory rate: 24 cpm
- Temperature: afebrile
- SPO2: 98% at RA
- GRBS: 783 mg/dL
04/06/23
- BP: 120/70 mm Hg
- Pulse rate: 88 bpm
- Respiratory rate: 22 cpm
- Temperature: afebrile
- SPO2: 98% at RA
- GRBS: 264 mg/dL
05/06/23
- BP: 110/70 mm Hg
- Pulse rate: 110 bpm
- Respiratory rate: 24 cpm
- Temperature: afebrile
- SPO2: 100% at RA
- GRBS: 181 mg/dL
06/06/23
- BP: 110/80 mm Hg
- Pulse rate: 114 bpm
- Respiratory rate: 22 cpm
- Temperature: afebrile
- SPO2: 96% at RA
- GRBS: 143 mg/dL
07/06/23
- BP: 110/80 mm Hg
- Pulse rate: 92 bpm
- Respiratory rate: 22 cpm
- Temperature: 99.2° F
- SPO2: 97% at RA
- GRBS: 165 mg/dL
08/06/23
- BP: 100/60 mm Hg
- Pulse rate: 88 bpm
- Respiratory rate: 24 cpm
- Temperature: 99.1°F
- SPO2: 98% at RA
- GRBS: 130 mg/dL
Fluid Intake and Urine Output
04/06/23
Total Input: 5000 ml
Total Output: 405 ml
05/06/23
Total Input: 2500 ml
Total Output: 1300 ml
06/06/23
Total Input: 1600 ml
Total Output: 700 ml
07/06/23
Total Input: 1600 ml
Total Output: 900 ml
08/06/23
Total Input: ml
Total Output: ml
Fever Chart
Systemic Examination
Cardiovascular System
- no thrills
- cardiac sounds S1 and S2 heard
- no cardiac murmurs
Respiratory System
- no dyspnea
- no wheeze
- trachea position: central
- breath sounds: vesicular
- no adventitious sounds
Abdomen
- shape: obese
- no scars, striae, engorged veins
- bowel sounds heard
- no bruits, rubs
- no shifting of dullness
- no fluid thrill
- hernia orifices: normal
- liver: not palpable
- spleen : palpable
Central Nervous System
Investigations
Treatment
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