Smoggy urine since 15 days

Male child age 13 comes in opd with complain of Smoggy urine since 15 days Chief Complaints Weakness Smoggy urine History No history of any morbidity Vitals Bp normal Pulse normal RBS: 498 Physical Examination Weak Anemic Investigations I Spontaneously check Rbs and result is shocking for both me and parents rbs: 498 I further advice Cbc Lft.kft Hb1ac Bs pp and fasting If anyone wants to add something please reply Diagnosis Type one DM ??? Uti?? Akd?? Management Need to be discuss

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Thanks for tagging me Dr Shoaib Aslam. In a busy schedule, iam not able to give you answer. This is a case of Type 1DM with? UTI. Look for ketone bodies to rule out DKA. Order for following investigations FPG PPG HbA1C CBP RFT LFT SERUM ELECTROLYTES FASTING LIPID PROFILE TFT Serum c peptide BASE LINE 12 LEAD ECG MICROALBUMINURIA CUE URINE FOR CULTURE AND SENSITIVITY. KETONE BODIES. Take complete history. Is there any acute weight loss History of polyuria, polyphagia and polydipsia. History of fatiguability and weakness. History of burning micturition. Family history of diabetes. Coming to the treatment, Advice admission under high consent. If they are not willing for admission, Start regular insulin if patient is in DKA Or Premix biphasic human insulin or analogue insulin if he is not in DKA Monitor serum electrolytes and blood sugars frequently. Correct dehydration. Start antibiotics for UTI until culture report comes. Correct Anemia with iron tablets.

whats smoggy urine . is there haematuria . is there family history of diabetes . another common cause of high blood sugar is rampant use of dexamethasone by quacks . does hb1ac has a role in diagnosis of diabetes . do cbc crp urine r/e n c/s blood sugar postprandial n fasting aso titre c3 level .

Smoggy urination may be due to Inadequate water intake UTI DIABETES Kidney stones Phosphoturea Invetigate accordingly and treat.

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Reassure about RBS Perform Clinical evaluation Assess severity of dehydration Assess neurological status Apply cardiac monitor Additional lab - urine ketone Vanous blood gas Electrolyte BUN Creatinine Management- Correct dehydration Correct acidosis and reverse ketosis Restore normal blood sugar level

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Do urine albumine creatinine ratio. Urine routine and microscopy smogy urine due to proteinuria advise usg abd to see kidney type 1 dm start on insulin

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Adv. Base line KFT and LFT. Rx Oral Antidiabetic.

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I am agree with@Dr. Sepuri Tirumala Devi Ma'am.

Thank you Dr Pranab Bera
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