Acute pyleonephritis on DKA







 E-LOGS GENERAL MEDICINE



 
Roll no 36
Hi, i am tejaswi5th Sem Medical Student. This is an online e-log book to discuss our patient's health data shared after taking his/her/guardian's consent. This also reflects patients centered care and online learning portfolio. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs. Hope this will be informative!

* This is an ongoing case. I am in the process of updating and editing this ELOG as and when required.

A 50 yr old female a resident of choutuppal came with cheif complaints of lower back pain on the left side since that day 4 am , vomitings since morning and constipation since 3 days


History of present illness 

Patient was apparently asymptomatic 13 yrs back . Later she had generalsed weakness , polyuria ,blurring of vision and unconscious for which she was taken to hospital and was diagnosed with diabetes for which she was given insulin injection . One and half yr back she absorbed polyuria ,  eye closings , weakness for which she went to  hospital and doctor prescribed medication tablets along with injection . 15 days back she hit her head to the fridge and developed one side headache . Later because of her polyuria and loss of consious for brought to our hospital and was treated for diabetic keto acidosis .  After one day stay at home the next day at morning 4 am she developed loin pain on the left side which radiated to the back . Its was a dragging type of pain back  she was admitted in our hospital on 22 july . She also had low grade fever associated  with chills  which relieved on medication 
She had two episodes of vomiting which was non projectile and non bilious type contents of vomiting inculded food and milk . She also had constipation since three days 
She had irregular bowel movements since 3 months now  hard stools with blood was seen sometimes . 


Past history 

K/c/o diabetes since 13 yrs 
K/c/a DKA 2 days back 
No history of hypertension , asthma , seizures , TB , CAD 
Hysterectomy done 18 yrs agoo

Personal history 

Her daily routine she is a housewife wakes up at 5 o vlock in the morning does her morning routine and household chores has her breakfast at 10 rests than lunch at 2 relaxes and evening snacks and night dinner at 9 o clock she sleeps by 10 o clock . 
Appetite reduced 
Sleep - insomniac since 3 months 
Vegetarian 
Micurition  incresased frequency polyuria 
Bowels movements irregular 
Has allergy of changapapu  ( chana dal ) a kind of dal 
No habits or addictions 

Treatment history 
Diabetes treatment 
Tab and injection 

Family history 
Father is a known case of diabetes 

Menstrual history 
Hysterectomy done 18 yrs back 

Obstetric history 
3 children 
3 gravida 3 para 3 live 
One boy and two girls  

Allergic history 

Allergic to Chana dall 

General examination 

Physical examination 

Pallor - Present 
Icterus - absent 
Cyanosis- absent 
Clubbing- absent 
Lymphadenopathy- absent  
Edema - absent  

VITALS : 

Temperature – febrile
Pulse rate –124 per min 
BP –160/80 mm of hg 
Respiration rate –24
GRBS –  327
SPO - 98 percent

SYSTEMIC EXAMINATION 
    CVS 
No Thrills 
Cardiac sounds S1,S2
No murmurs 

RESPIRATORY SYSTEM 

Dyspnoea - absent 
Wheeze - absent 
Position of trachea - central 
Breath sounds are vesicular

ABDOMINAL EXAMINATION 

Abdomen  scaphoid shape 
Tenderness  present left loin 
No palpable mass 
Hernial orifices normal 
free fluid absent 
No bruits 
Liver is not palpable 
Spleen is not palpable 
Bowel sounds heard 

CNS 
 Conscious
Speech is normal 
Signs of meningeal irritation- no neck stiffness
                                           No kernigs Investigations ordered 
 2 d echo                                         












 Blood culture 
14
15 
16 


Usg 




Ecg 





monitoring 








Provisional diagnosis 


Diabetic keto acidosis secondary to sepsis caused by bilateral pyelonephritis 
 

Treatment 

1) normal diabetic diet 
2)inj HAI 
3) inj NPH
4) inj meropenam 1gm/ ml / BD
5) TAB nitrofurontion 
6) IVF NS and RL 75 ml / hr 
7) inj meomol 100ml 
8) Tab  naxdom250 mg 
9) Tab orofer
10) TAb b - complex 
11) vital monitoring 






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