Polyuria & Polydipsia

Chief complaint A 26 year old male complains of polyuria, polydipsia, blur vision, and dry mouth for 10 days. He also has abdominal pain History The patient is obese and complains of 10 kg weight gain over 2 years. Vitals BP 168/115 mmHg, RR normal Investigations Glucose of 795 mg/dL [69-99 mg/dL], Potassium of 2.5 Mmol/L [3.6-5.2 Mmol/L], Hemoglobin A1c of 14.2%, Triglycerides of 486 mg/dL [<150 mg/dL] Metabolic alkalosis Diagnosis What are your comments?

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Obese patient with striae distensiae, and Acanthosis nigricans. Obesity ,hypertension, DM, Dyslipedemia all form Metabolic syndrome ,due to insulin resistance. Need to rule out Type 1 DM( Mody ) considering young age of onset . Estimation of insulin and C Peptide will clear this doubt. Need to assess end organ damage and DKA. Admission IV Actrapid, hourly, with 1/2 normal saline infusion ,( since patient is hypertensive) , IV potassium chloride, statins and Fenofibrate. Anti hypertensive, preferably ARB. Once sugar is controlled , life style modifications ,to reduce weight and control sugar. Diet, exercise . Inj Lantus + actrapid once daily , with SGLT 2 inhibitor, + gliptins / glimipride can be considered once patient's sugar is controlled well . Patient education is important since this is a life long battle.

Hypokalamia with hyperglycemia Uncontrolled hba1c Blurred vision with Polydypsia and polyurea suggest pt heading to DIABETIC KETOACIDOSIS and likely in hyprrglycemic coma Hence needs ICU management Put him on insulin pump And inj kcl drip Uncontrolled hypertension get control gradually Manage triglyceridemia with rosuvastatin

Thanx dr A Dutta
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UNCONTROLLED DIABETES WITH.. ASSOCIATED COMPLICATIONS.. & .. HYPERTRIGLYCERIDEMIA.. NEED'S.. ENDOCRINOLOGIST OPINION..

Tnx Dr Vipin Bihari Jain
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Clear symptoms of Diabetes mellitus and that too high. Hypertension is high. Both require immediate treatment

Thanks Dr. Kute Ankush,Dr.A. Dutta, Dr. Mustafa Kiomars
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Uncontrolled diabetes mellitus with hypertension with hyperlipidemia

Young age and very high blood sugar It is indicative of insulin dependent diabetes mellitus or insulin resistance This patients needs insulin for control of blood sugar He has hypokalemia, which may become aggravated after administration of insulin, therefore he may need show infusion of potassium in addition to insulin Majority of symptoms are related to very high blood sugar Blood sugar need to be lowered slowly in order to avoid cerebral oedema because of rapid lowering of blood sugar Adequate hydration need to be maintained Antihypertensive for treatment of hypertension Serum C peptide level, Antibody to be checked Islet cell antibodies, antibodies to glutamic acid decarboxylase (GAD-65), insulin autoantibodies (IAA)

All vitals and basic metabolic order is worst effected. Long way to go. First best diabetes co trolled under consideration of Diabetologist and BMI correction below 30 by advice of nutritiona and dieticianl expert.

Acanthosis nigricans +nt (It is the sign of DM) Distensiae striae +nt (due to obese) Uncontrolled DM Dyslipidemia Refer to endocrine department.

Investigation : Urine examination Creatinine/ urea level ESR
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Start iv insulin infusion .iv fluids sc insulin injections......check urine ketones ,c peptide GAD antibody

Cushing syndrome

Uncontrolled diabetes insulin drip hrly check sugar hypokaelemia
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