Uncontrolled dm /ketosis/lvf ef 40%

K/c/ dm for 8 yrs on oha + insulin Having loose motion from yesterday Treated with iv fluid by nearby doctors but having sudden onset of ghabrahat with sweating with breathlessness Admitted with bp 90/70 hr 102/min rbs 500+ ketone + Spo2 88% rr-32/min Chief Complaints Sweating Ghabrahat Restless Breathlessness Physical Examination Cns restless Cvs Techie cardia Rs tachypnoea Diagnosis Dm/ketosis/?lvf

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? UNCONTROLLED DIABETES .. DKA .. WITH .. DYSPNEA .. GHABRAHAT .. SPO2 .. 88 .. NEED'S .. HOSPITALIZATION .. CLINICOPATHOLOGICAL EVALUATION WITH .. HEMOGRAM.. URINE ROUTINE.. BSL .. FASTING & PM .. HBA1C .. ECG STUDY .. CARDIAC PROFILE .. STRICT GLYCEMIC CONTROL WITH ANTIDIABETIC MANAGEMENT.. WITH .. INSULIN .. OHA .. ENDOCRINOLOGIST OPINION..

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Diabetic pt recieved iv fluids and post treatment pt has hyperglycemia hence we need to know earlier diabetic status as pt was receiving insulin Suspicious infusion of iv dextrose will result in hyperglycemia Pt is hypoxic as sp02 is 88% Cardiomegaly Probably over transfusion Adv ecg 2decho Cbc esr urine Manage hyperglycemia by plain isulins with 4hrly monitoring Niv 02 support Inj lasix Check sr electrolytes

Age??? case of severe hyperglycaemia. Reports:cardiomegaly with increased haziness at LLZ. -Pathogenesis:severe hyperglycaemia caused - increased ketone bodies due to lipolysis. -osmotic diuresis with intracellular dehydration. -with loose motion episodes added extra losses of bicarb ions. -ptn in metabolic acidoses. -Acidosis caused - helps vasodilation which leads to hypotension and in shock. -increased respiration rate-tachypnoea important investigation:Sr.electrolytes. ABG.ECG

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? Dka

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Send ECG and cardiac markers, get 2D ECHO done. As well if he had COVID infection recently? If not symptomatic, confirm by COVID total antibodies. Of course on the other hand, manage DKA with shock. Need to establish which type of shock is this, whether it is cardiogenic or septic or hypovoluemic shock. HRCT chest could also be done to cut down time.

Ecg - sinus trachycardia Echo dcmp lvf ef 40% Covid negative
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