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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