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COPD with HTN with T2 DM associated with haemoptysis

Today morning I got a call from neighbor before coming to my hospital duties for 24 hoursSeen patient & requested his son to send reports. On request given reports as per my capabilities. K/C/O T2DM with HTN with COPD. On medication by specialists Present C/O Blood stained cough since last night, febrile conditions, thrust, difficulty in passing urine. P/H/O similar episodes in last year O/E PR 112 BP 120/80, Mod dehydration H/L NAD, Only impaired BS Pt is alert & cognitive Enclosing Xray & blood reports Xray COPD with Emphysema Both basal atelectasis Rt dome of diaphragm retracted with underlying collapse lung Bronchiectatic changes noted ECG Sinus tachycardia RAD LAHB Anterior wall ischemia R/O DKA Advice further & valuable opinion pls & correct me Advised hospitalization

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Blood stained cough with fever Investigation shows Normal blood pressure with severe Tachycardia Normal WBC count, normal serum creatinine, high blood sugar X Ray chest shows emphysematous overinflated lung fields ECG shows RBBB - RSR' pattern in lead V1 with wide QRS complex Impression Fever, normal WBC count and tachycardia are very common in COVID 19 Adv Check for urine ketones Please send nasal swab for RT PCR Strict control of blood sugar is most important and effective intervention in treating underlying pathology - in view of high blood sugar, regular insulin infusion to be started with monitoring of blood sugar Sonography of chest and abdomen to look for fluid status - fullness of IVC, Left ventricular ejection fraction, B lines on sonography of lungs Fluid administration according to fluid status evaluation by sonography Check saturation on pulse oximetry, send arterial blood gas to check pH, pO2 and PCO2, treatment according to values
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Diabetic ketoacidosis. Admit in ICU under Endocrinologist. IV Regular insulin 10 IU IV bolus then (0.1 IU/kg/hour) 3 way cannula . IVF with NS 1 bottle in 30 minutes next 2 bottle in 1 hourly next 2 bottle in 2 hourly.( there is severe dehydration in DKA 5-7 litre) Inj Potklor- In IVF NS BD 12 hourly( as there is Hypokalemia due to IV insulin infusion) Inj PPI. Inj NaHCO3- IV TDS ( correction of metabolic alkalosis) Inj Cefriaxone. Moist O2 SOS. Check FBG 30 minutes interval. Blood for CBG Hb TC DC and ESR Cr Na K PO4 HCO3. Urine for RE ME ketone Body. Pulmonologist, Cardiologist, Endocrinologist follow up .
Valuable opinion
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Pt look's to be in DKA Uncontrolled diabetes high bsl levels Xray chest not very clear but yes COPD Ecg suggest tachycardia NSR Lt axis deviation Old ischimic changes Manage by iv inj NS Inj sodabicarb Inj lasix Control sugar by plain insulin Send sputum for lab Adv hrct Sr electrolytes Lfts and KFTS Increase output Compensate dehydration Inj Ceftriaxozone and sos inj paracetamol
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Cxr showing Copd with emphysema Evidences of collapsed lung especially rt lung..... Evidence of PAH Adv bronchoscopic exam......r/o any growth causing obstruction.
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Copd emphysema bilateral basal pneumonitis ideal hrct with ant wall ischemia tachycardia rad 2 decho diabeticdd effusion covid era do covid 19 admit
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It is a c/o .. Uncontrolled DM.. with.. DKA.. and.. ? Haemoptysis.. Need's.. Investigations to..r/o.. Covid -19 .. As per protocols..
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I do not think the patient is in DKA....however confirm by urine ketones
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It’s a uncontroll t2dm May be DkA we can do one more HbA1c
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Diabetic ketoacidosis Sinus Tachycardia ischemic stroke.
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Uncontrolled DM ,COPD, lung infection ? DKA Hospitalisation ,ABG Sputum for AFB and CBNATT Correction of dehydration with normal saline, IV Insulin infusion, antibiotics, Nasal O2, nebulizers, chest physio, correction of acidosis
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