A 45 year old male shopkeeper came to the casuality with chief complaints of chest pain since 2 days .

This is an online E-log book to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through a series of inputs available global online community of experts with the aim to solve the patient’s clinical problems with the collective current best evidence based inputs. This E log reflects my patient centred online learning portfolio and your valuable inputs in the comments section. 



 A 45 year old male  shopkeeper  came to the casuality with chief complaints of   chest pain since 2 days .

HOPI :- 

Patient was apparently asymptomatic  7 years ago .

patient was chronic alcoholic since 20 years , 360 ml / daily ,whisky .

patient  complaints of pain abdomen and was diagnosed with acute pancreatitis and diagnosed as DM 2 , similar episodes 2 times , the first one 7 years back and the second one 4 years back.

He had H/0 of irregular insulin intake , came to the casuality in drowsy state and treat for DKA.

last binge of alcohol 2 days back (90 ml) since then complaining of , chest pain : burning type , radiating to back.

No complaints of palpitations and syncopal attacks 

c/o  sob grade 3-4 , aggravating on talking 

no c/o orthopnea , paroxysmal nocturnal dyspnea 

no c/o burning micturition 

PAST HISTORY :- 

K/C/O DIABETES   since 20 years 

Not K/C/O. HTN,DM, EPILEPSY, CAD  


GENERAL EXAMINATION :- 

Patient was conscious , coherent and cooperative.

Pallor - absent

 Icterus- absent

Cyanosis- absent

Clubbing - absent

lymphadenopathy- absent

Edema - absent

vitals :- 

temp.  afebrile 

BP 120/80 mm hg 

Pulse 96 bpm.

RR 22 cpm

spo2 100 @RA 

GRBS  468 


SYSTEMIC EXAMINATION :- 

CVS :- S1 , S2 heard 

RS. :- bae present 

P/A : soft , non tender 

CNS :- sensory system-  intact 

                 motor system - intact 

                 






 INVESTIGATIONS:

ECG :


Chest x ray :



PROVISONAL DIAGNOSIS :- DIABETIC  KETOACIDOSIS  

TREATMENT :- 

1.Inj HAI  6 U   iv /stat 

2.inj HAI 1ml in 39 ml ns according to infusion algorithm 

3.inj pantop 40 mg iv /bd 

4.inj zofer 4 mg iv /sos

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