A 46 years old male admitted with complaint of weakness for 3 days with history of increased urination for last 3 weeks. On examination vitals stable. Admission RBS was 650mg/dl. ECG is attached. Diagnosis and management?



C/o newly detected type 2 DM with most probably DKA. How is ABG ? Analyse for the underlying cause. Ecg s/o Diffuse St-t changes in all leads with Prolonged QTc.... Evaluate metabolic parameters like Hypokalemia/ Hypomagnesia (following Insulin infusion/ Dehydration) Check for ionic calcium and serum Na. Followed by correction. ABG. Rest managing as per the guidelines.

Newly diagnosed uncontrolled DM with ho osmotic diuresis since 3 wks symmetric t wave inversion s / o hypokalaemia rule out HCM in view of biphasic t wave in v3 adv troponin I if positive consider wellens syndrome BSL control with soluble insulin drip adv early echo

Sir wellen syn is usually t wve inversion in v1 v2 ns sometime v3...

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Uncontrolled diabetes Possiblity of diabetic ketoacidosis with given history Get done plasma acetone with urine ketone ABG or VBG Hydrate him Routine lan with electrolytes with renal function test Usg abdo pelvis Control sugar with actrapid infusion Ecg shows LVH staring pattern 2decho Control BP

If the patient has DM then insulin infusion has to be started. Check electrolytes.ketones in urine.even thoughEcg shows ischaemic changes and Trop negative ,one cannot rule out ICD too

It's a case of severely uncontrolled DM2 with CAD Blood sugar very high need to do ketones electrolyte kft lipid profile Mx:- Start insulin accordingly imidiatly Replace electrolyte if deranged Start NTG drip LMWH inj as per schedule Statin Loading dose clopidogrel Most important keep hydration mentioned If required shift patient to ICU

Seems like type 2 DM with hyperosmolar state..check ABG urine for ketone..electrolytes..give insulin infusion..treat accordingly..

Hypokalemia. Get potassium levels checked.

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Type ii DM goes into hyperosmolar coma rarely DKA, Check reason for so high sugars, Could be sepsis as there is short 3 day history of symptoms. Urinary examination incl ketones, blood gas analysis, CBC and chest x-ray are mandatory. ECG has ischemic features but may settle once electrolytic abnormality is taken care of

As pt is having very high sugar levels he may be in Daibetic ketoacidosis with above ECG changes so first he ahold be assessed clincaly for level consciousness then his urine output & other parameters should be constantly monitored hrly Bsl electrolytes Na k HCO3 levels & enzyme studies like Tropnin labels Bun s creatinin & CPk or sholud be on. Continus. Insulin 4 I u per ml विध IV sodabicarb O2 should be started & as soon as pt is stabilised 2 d echo should be done for cardiac Statius done & treated accordingly

Widespread st t changes Check S.K, S.Mg Correct metabolism & if such findings persist than ECHO

Ecg showed lateral wall ischemia Urine ketone test, KFT, LIPID PROFILE,A BG IF Urine ketone become positive, start IVF FLuid NS with injection insulin also do the serum electrolytes and check for potassium level. And correct it if abnormal Also start Tab aspirin 75mg OD Tab clopidogrel 75mg OD Tab atorvastatin 40mg HS PLAN FOR 2D ECHO

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