A 21yr old male patient with diabetic ketoacidosis

 4th October 2021

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Chief complaint 

A 21year old male patient presented to opd with complaints of fever since 1week

History of present illness

Patient was apparently asymptomatic 1week back.He,then developed fever with chills which is insidious in onset,low grade and intermittent which relieved on medication

History of vomtings-1 episode,projectile and bilious type

Shortness of breath is present 

History of weight loss is present 

Fatigue is present 

No history of cold and cough 

Past history 

No history of hypertension,diabetes,epilepsy,TB

Personal history 

Decreased apetite

Mixed diet

Adequate sleep

Bowel and bladder -normal

No history of smoking and consuming alcohol 

Family history

No relevant history found 

General Examination  

Patient is conscious, coherent and cooperative 

Moderately built

Pallor is present 

No cyanosis,clubbing,icterus,lymphadenopathy and pedal edema

Vitals 

BP: 140/90 MMHG, 

PR: 120bpm 

Temp: 98.2°F, 

RR: 40 CPM, 

SPO2: 99% 

Systemic examination 

CVS

No thrills

S1 S2 +

No murmurs

Respiratory system 

BAE+

No dysponea

No wheeze

Position of trachea-central

Breath sounds-vesicular 

Adventious sounds-rhonchi

Abdomen 

Shape of abdomen-scaphoid 

No tenderness

No palpable mass

Hernial orifice-normal 

No free fluid

No bruits

Liver-not palpable

Spleen-not palpable 

Bowel sounds-present

CNS

Level of consciousness-alert

Speech-normal

No signs of meningeal irritation 

Investigations 

FEVER CHART

HEMOGRAM

COMPLETE URINE EXAMINATION

PERIPHERAL SMEAR

RETICULOCYTE COUNT 

SERUM ELECTROLYTES 

LIVER FUNCTION TEST

URINE KETONE BODIES 

BLOOD UREA 

BLOOD SUGAR 

SERUM CREATININE 

X-RAY

PROVISIONAL DIAGNOSIS 

DIABETIC KETOACIDOSIS WITH DENOVO DETECTED DIABETES MELLITUS WITH VIRAL PYREXIA UNDER EVALUATION

TREATMENT 

1)NBM till further orders

2)IVF 3lit NS  @500ml/hr(in 3hrs) f/by IVF NS@250ml/hr 

3)Inj. HAI 4IU IV/stat f/b Inj. HAI 1ml (40IU) in 49ml NS @ 4ml/hr(untill ABG correction)

4)Inj. PAN 40mg IV/OD

5)IVF 5%DEXTROSE @50-100ml/hr(when GRBS <150) [increase/decrease acc. to GRBS]

6)Inj.OPTINEURON 1amp in 100ml NS/IV/OD 

7)GRBS monitoring hourly

8) Strict i/o. Monitoring

9)Inj. KCl 2amp in 500ml NS @100ml/hr

QUESTIONS

What could've been the stimulating factor for diabetes and is fever alone is the cause of eliciting insidious diabetes??