9 year boy presented to emergency with multiple episodes of vomiting epigastric pain and 1 episodes of seizure after few hours of ingestion of some fruit when he went with his friend in nearby jungle. He is unconscious with GCS 7/15, pupils are dilated and reactive, BP is 70/40 mm Hg, B/L crepitus and wheezes on chest auscultation, on lab investigation blood glucose level is 506 mg/dl , sodium-160 pottasium- 2.9. Urine output is >5 L/day.Today is his 9 the day of ICU and is still unconcious . Doctor used medicines like insulin, dexamethasone, vasopressin and iv fluids. Diagnosis?

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This may be first episode of DKA of IDDM. Have urinary ketone bodies done: Hypernatremia may be due to dehydration( polyurea) Treat with fluids, iv insulin, antibiotics: check lytes, fluid overload/dehydration: take care of K.

Urinary ketone body is negative sir
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Hyperosmolor hyperglycemic state IV fluids Normal Saline-target CVP 8-10 IV Insulin Electrolyte balance Suggest: RFTs Sr.Electrolytes Sr.Bicarbonate Sr.Osmolality Urine routine Routine labs

The seeds seem to be oleander seeds. Oleander poisoning?

Cerebral edema( rapid correction of blood sugars/ electrolyte imbalance) might be responsible for low GCS & pupillary dilatation.

Pupils are mid dilated and fixed
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Seems to be a case of baladona poisoning.(Dhatura)

The fruit doesn't seems to be balladona sir
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datura oleander Airbus prictarious poisoning

Seems like baladona poisoning

Dr is still giving vasopressin to correct polyuria.
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Rule out acute intermittent porphyria . Send for urine porphyrins . Iv hematin for 4 days can be tried alongwith supportive management

Inj.adrenaline to treat shock add Kcl take help of .botaney professor to know fruit

But there is no urinary retension,dysuria instead there is polyuria

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