A 21 year old male patient with Diabetic ketoacidosis with denovo detected diabetes mellitus with viral Pyrexia under evaluation

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CHIEF COMPLAINT:

A 21year old male patient came to casualty with chief complaints of fever since 5 days.

HISTORY OF PRESENT ILLNESS:

Patient was apparently asymptomatic 5days back then he developed fever which was  insidious in onset, intermittent and was of  low grade type also with chills and relieved on medication. 

Pt had h/o 1episode of vomiting which was bilious, projectile.

No h/o any burning micturition, throat pain, cold,cough.

Shortness of breath present. 

Fatigue-present. 

PAST HISTORY:

Not a k/c/o HTN,DM, CAD, asthma, TB, epilepsy.

PERSONAL HISTORY:

Patient has mixed diet with normal appetite and adequate sleep. 

he has normal bowel movements and bladder filling. 

No addictions. 

No significant family history or allergic history. 

GENERAL EXAMNATION:

Patient is c/c/c ,moderately built and moderately nourished. 

Moderately built 

Patient was pallor.

 

No icterus, cyanosis, clubbing, lymphadenopathy, pedal edema. 

VITALS:

BP: 140/90 MMHG, 

PR: 120bpm 

Temp: 98.2°F, 

RR: 40 CPM, 

SPO2: 99% 

SYSTEMIC EXAMINATION:

RESPIRATORY SYSTEM:

BAE +

NVBS heard

CARDIO VASCULAR SYSTEM:

S1 ans S2 heard. 

No murmurs.

No thrills

PER ABDOMEN: 

soft and non-tender. 

CENTRAL NERVOUS SYSTEM:

No focal deficit 

INVESTIGATIONS:

1) HEMOGRAM : 

Hemoglobin: 8.2 gm/dl

TLC: 15800

Neutrophils:89

Lymphocytes:6

PCV: 30

Mcv:63.7

MCH:17.4

MCHC:27.3

Platelet count:3.37 lakhs/cu.mm

RBC:4.71 lakhs/cu.mm

Chest x-ray:

DAY-2:

DAY-3:

GRBS-157 mg/dl

PROVISIONAL DIAGNOSIS:

Diabetic ketoacidosis with denovo detected diabetes mellitus with viral Pyrexia under evaluation. 

TREATMENT:

On DAY-1:

1)NBM till further orders

2)IVF 3lit NS  @500ml/hr(in 3hrs) f/by IVF NS@250ml/hr 

3)Inj. HAI 4IU IV/stat f/b Inj. HAI 1ml (40IU) in 49ml NS @ 4ml/hr(untill ABG correction)

4)Inj. PAN 40mg IV/OD

5)IVF 5%DEXTROSE @50-100ml/hr(when GRBS <150) [increase/decrease acc. to GRBS]

6)Inj.OPTINEURON 1amp in 100ml NS/IV/OD 

7)GRBS monitoring hourly

8) Strict i/o. Monitoring

9)Inj. KCl 2amp in 500ml NS @100ml/hr

On DAY-2:

1)IVF 0.45% NaCl,RL @100ml/hr 

2)Inj. KCl 2amp in 500ml NS @100ml/hr

3)Inj. HAI 1ml (40IU) in 39ml NS @ 4ml/hr(untill correction of acidosis)

4)Inj. PAN 40mg IV/OD

5)Inj.OPTINEURON 1amp in 100ml NS/IV/OD 

6)GRBS monitoring hourly

7)Strict i/o. Monitoring

8)NBM till further orders

On DAY-3:

Stopped insulin infusion

Started Inj. NPH S/C according to grbs(8am---2pm---8pm)

Inj.HAI S/C acc to grbs

IVF NS,RL @100ml/hr

INJ.PAN 40mg

FEVER CHART:

Questions:

What could be the stimulating factor for diabetes?