Final exam short case

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A 43 yr old female patient came to the casualty with a chief complaint of  lower backache since 2 days , pain abdomen and vomiting since 1 day 

HISTORY OF PRESENT ILLNESS:

Patient was apparantly asymptomatic 6 yrs back , then  she had anasarca went to the local hospital and diagnosed to have hypothyroidism (started on tab.Thyronorm 50 microgram) &  also DM  ( started on injection MIXTARD ) and  also got diagnosed for renal failure & was on tab.Torsemide 20 mg+ spironolactone 50mg .

Patient complaints of pain abdomen which is diffuse , intermittent  associated with vomitings (2 episodes) .

No history of fever, cold, cough, loose stools, constipation, Malena, haematuria.

No history of pedal edema, decreased urine output, facial puffiness.

PAST HISTORY:

Patient is known case of DM since 6 yrs  and is on ( inj. MIXTARD ).

Patient is also known case of hypothyroidism since 6 yrs ( tab thyronorm 25 micrograms)

No history of hypertension, CAD , asthma, epilepsy, tuberculosis.

PERSONAL HISTORY:

Diet : mixed

Appetite : decreased 

Sleep : adequate

Bowel& bladder movements : regular 

 No addictions. 

Family history:

Patient mother is a known case of diabetes mellitus.

General examination-

Patient is conscious, coherent and cooperative well oriented to time, person and place. 

No pallor , icterus, cyanosis, clubbing , generalized lymphadenopathy.

Vitals-

Temperature -  Afebrile 

Bp-150/80 mm hg

Pulse rate -  88bpm

Respiratory rate - 21cpm

Spo2- 99% on RA

SYSTEMIC EXAMINATION : 

RS- decreased breath sounds on B/L IAA & ISA 

Cvs-S1 S2 +

P/A - soft, diffuse tenderness + 

Cns- NAD 

INVESIGATIONS : 

PROVISIONAL DIAGNOSIS : 

pain abdomen secondary to uncontrolled sugars with DKA with ? (CKD secondary to metabolic acidosis ) with metabolic acidosis secondary to DKA & CKD with H/o DM, hypothyroidism , CKD

TREATMENT PLAN:

1) IVF – 0.9% NS @ 150ml/hr

2) INJ. PANTOP 40mg IV/OD

3)INJ.ZOFER 4mg IV/TID 

4) INJ. METROGYL 500MG /IV / TID

5) INJ. TRAMADOL 1AMP IN 100 ML NS /IV/TID 

6)INJ. INSULIN INFUSION WITH 2ML/HR 

7)INJ.BUSCOPAN 2CC IV/SOS

8)INJ.LASIX 40MG IV/BD

9) TAB.THYRONORM 50microgram PO/OD