Diabetes management oha/insulin management

30 year old male, 10 day history of diarrhoea and reduced oral intake, presented with lethargy and ongoing abdominal cramps. No respiratory symptoms, but O2 sats noted to be on the lower side, exertional O2 sats dropped to 86%. No past medical history of note, normal white cell count, not lymphopenic, urea 18.9 mmol/L, creatinine: 489 µmol/L, amylase 600 (30-118), ALT: 65, CRP: 100, Trop I 267 (0-46). Chest X-ray as shown. What do you think the patient is suffered from?

pt of RHD not on warfarin ...presented with abdominal pain with brownish discoloration over abdominal wall ..since 6 days with abdominal tenderness ...jvp was raise and b/L pedal oedema ..on routine INR was 1.7, platelets 50000,wbc -14700, bilirubin 6 ,with sgot and sgpt was 100 and 300 ,kindly comment ....

43 yo male came to the ER with severe SOB and coughing. Toxic and mildly feverish lethargic. Decreased air entry spo2 80.% crepits with wheezes. This is his CXR ! Opinions, please.

78 y/o female complaints of severe right upper quadrant pain that radiated to the epigastric region and back associated with nausea and nonbilious vomiting. PMH: chronic pancreatitis, congestive heart failure, and poorly controlled type 2 diabetes. She underwent a remote cholecystectomy. Temp: 39.3°C, BP: 159/73 mm Hg, She appeared to be in severe distress. The epigastric and right upper quadrant regions were very tender to palpation. -Elevated serum glucose (369 mg/dL), low serum sodium (131 mmol/L), chloride (94 mmol/L), and bicarbonate (19 mmol/L). -Urine sample showed ketones, while serum BHB was elevated (1.64 mmol/L). -CT of the abdomen revealed duodenal thickening. Diagnosis of diabetic ketoacidosis was made and started appropriate treatment. She continued to vomit despite the use of anti-emetics, bowel rest, and diabetic ketoacidosis treatment. Upper endoscopy showed a distally black esophagus. What is it? How to proceed with treatment?

A 60 yr old female k/c/o T2DM, CAD (Post PTCA) Hypothyroidism presented with complaints of sudden onset breathlessness since 3 hrs....She went to some nearby doctor who gave her Loading dose in view of ACS...This history was not revealed in hospital...So in ED, the patient was agn given loading dose and was suspected of having acute LVF and was put on Bipap...In the morning, patient improved a little but strtd bleeding from angle of mouth....A history of small gastric ulcer was revealed (3 yrs back)...Vitals were 200/100 mmHg , PR- 90, at presentation....In morning, BP- 140/80 PR- 88/min....Discuss the treatment approach to this patient....