case ppt DM

8/2/2019 case ppt DM

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CASE Presentation

Diabetes Mellitus

RESOURCE PERSON: Dr. Abhiruchi GalhotraPRESENTED BY: Dr. Dinesh Mirok


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Presenting the case of Jagat Ram, 53

year old male Married

Businessman

Religion: Hindu

Address: s/o Brij Lal resident of

Ambala City, Haryana.


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Presenting Complaints:

Fever since 15 days, pain in upper abdomen

since 15 days and K/C/O Diabetes since 5

years

History of present illness:

The patient was apparently well 15 days back

when he started complaining of fever.

It was sudden in onset, continuous in natureand accompanied with rigors and chills. There

were no complaint of rashes.


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He was also having pain in the right upper

quadrant (RUQ) involving rt. Hypochondriacand Epigastrium regions of the abdomen.

The pain was severe in intensity, continuous

and non radiating in nature.

The patient took some analgesic + antipyretic

from some local practioner for the same and

got relieved for some time only.


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After that the patient went to the trauma centre,

Ambala and from where he was referred toGMCH, Chandigarh

He was admitted in GMCH on 24th August where

his investigations showed following results:

Hb: 11.5 g/dl

TLC: 21000

Platelet count: 2.5 lakh

DLC: 85/08/01/01


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Na+: 139 mEq/ dl

K+ : 4 mEq/dl Urea: 38 mg/dl

Creatinine: 1.2 mg/ dl

SGOT: 71.9 IU/L

SGPT: 105.7 IU/ L

ALP: 631.7 IU/ L


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S. Bilirubin: 12.6 mg/dl

FBS: 230 mg/dl USG abdomen showed hepatomegaly with

liver abcess


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The patient is also a k/c/o Diabetes Mellitus

His chief complaints prior to diagnosis werepolydipsia , polyuria and weakness in the legs.

He went to a private doctor in Ambala for

checkup, who told him to get his random blood

sugar level which was reported as 400mg/dl.

He was then diagnosed as case of T2DM for

which he was taking oral hypoglycemics

( Glimperide + Metformin).


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According to the patient his sugar level was

completely fine throughout after he startedthe medicine although he is not carrying

any authentic proof for the same.

No h/o HTN

No h/o Peripheral Neuropathy

No h/o Nephropathy (as told by the patient)

No h/o any visual disturbance


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Past history:

No significant history of any other long termillness like hypertension, TB, any similar

episode or any other chronic illness in the

past

Family History:

No family h/o hypertension ,TB ,Endocrinopathies or any other chronic disease

in family.


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Personal History:

Non Vegetarian, Non Smoker

Non-alcoholic

Bladder, bowel habits are normal

Sleep : normal for 8-10 hours day

The patient goes for a morning walk dailythat is 2- 3 Km (as told by the patient)


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Socio Economic status:

Education : Graduation

Occupation :Businessman Income:

Approx. Rupees 30000 per month from all

sources

Per capita income: Rupees 5000Score:

Occupation : 5

Education : 6

Income : 6

Total : 17

Social Class: II (Upper Middle)


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Environmental History (as told by the

patient)

Lives in Pucca house, floor cemented, roof

is present

Number of floors: 2

No of rooms per floor:2, patient lives on top

floor with wife

No of doors in house: 5

No of windows: 6


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Cross ventilation: Present

Personal toilet is present

Water Supply: Tap Water ,storage tank

present in house

Filtered Drinking Water facility is available

in the house

Cooking: Uses Gas, Smoke vent is present

No pets at home

Rodents ,Mosquitoes present Uses repellants for Mosquitoes


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Dietary History (Before Hospitalization):

Breakfast : 1 Prantha + 1 glass milk + 2 eggs (boiled)

Lunch :

Rice (2 katori )+ 4 katori veg + 4 chapatiEvening :

1 cup tea without sugar

Night :

4 chapati + I katori Dal +1 glass milk


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Total calorie and protein intake:

Total intake (in 24 hours )

Energy Proteins

Intake (past 24 hours) 1910 Kcal 60gm

Required intake 1200 Kcal 25gm

Excess 710 Kcal 35gm


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Daily Intake in Hospital:

Early Morning: 1 Cup Milk without sugar

Breakfast :

1 Katori Dalia +1 Cup Tea Lunch :

1 Katori Dal + 2 Chapattis + 1 Katori Curd

+ Green Salad with lime

Evening : 1 Cup Milk (without sugar)with 2 Bread

Slices


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Night :

Katori Khichdi + 1 Katori Curd + GreenSalad with lime

Total intake (in 24 hours )

Energy Proteins

Intake (past 24 hours) 1175 Kcal 25gm

Required intake 1200 Kcal 25gm

Deficit 25 Kcal -


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Treatment history :

Taking OHD for T2 DM

General physical examination:

Patient was calm, cooperative, conscious and

well oriented to time, place and person Built :Well built

Height : 171cms

Weight : 89 kg

BMI : 30.4


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Pulse :100/min ,regular, no radio-femoral

delay, all peripheral pulses are palpable Blood pressure :

1st reading-------130/84mm Hg

2nd reading ------130/80mm Hg (after

2 mins)


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Respiratory Rate :24/min

Pallor : +

Icterus: +++

Clubbing : -

Koilonychia : -

Lymphadenopathy : +

Edema : +

Thyroid: normal


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SYSTEMIC EXAMINATION :

Abdominal examination :Tenderness present

Hepatomegaly

No other abdominal mass felt

Bowel sounds heard

Eye examination :

Visual examination : WNL


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CVS :

S1,S2 Heard

No parasternal heave,

No murmurs

Respiratory system:

Normal vesicular breath sounds

No adventitious sounds

Trachea midline

Nervous system examination :

No neurological deficit present Reflexes normal

No facial asymmetry


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Provisional diagnosis:T2DM with Liver abscess

Investigations and Follow up: FBC: Hb, TLC, DLC

LFT

Culture liver abscess

CECT abdomen

Comprehensive diagnosis :

Jagat Ram, 53 year old male upper

middle(II) socioeconomic status,nonsmoker, non-alcoholic is sufferingfrom T2DM with Liver abscess


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Treatment being given to the patient:

Inj. Insulin 4U TDS, Inj. Tramadol 100mg

SOS, Inj. Metrogyl 400mg BD, Inj. Rantac

150mg BD, Inj. Ceftrixone BD, Inj. Vit K

Low calorie diet as told by the dietician


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Thank You

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