case ppt dm
TRANSCRIPT
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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