A 55 year old female with DKA with Diabetes mellitus with compound fracture of left lowerlimb with external fixator
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A 55 year old female came with C/o fever since 4 days, high grade , relieved on medication.
C/o of SOB since 4 days , progressive in nature
SOB at rest ( Grade 4).
HOPI: The patient was apparently asymptomatic 4 days back then she had a H/o RTA ( Fracture of left lowerlimb) S/p wound debridement with external fixator under spinal anaesthesia)
H/o pus discharge from external fixator site.
Grade 4 SOB progressive in nature ( At rest) a/w lower back ache and generalised body pains.
PAST HISTORY: k/c/o Diabetes mellitus 2
Not a K/c/o HTN, TB,CVA ,CAD ,Epilepsy ,Asthma
PERSONAL HISTORY:
Diet: Mixed
Appetite: Normal
B&B: Regular
Addictions: No addictions.
O/E
General examination
Temp: 98.9 F
PR: 100 bpm
BP: 130/90 mm hg
RR: 22 cpm
SpO2: 98% @ RA
GRBS: 387 mg / dl
Systemic examination
CVS: S1S2 + , No murmurs
RS: BAE + , NVBS
P/A: Soft , NT
CNS: No FND
INVESTIGATIONS
TREATMENT:
IVF NS & RL continuous infusion @ 180 ml/hr
Inj. HAI 8 units/IV/STAT
Inj. HAI 10 ml in 39 ml NS IV @ 6ml/hr
Inj. MEROPENEM 1gm IV/BD
Inj. VANCOMYCIN 1 gm in 100 ml NS IV/BD
Inj. PAN 40mg IV/OD
GRBS Monitoring hourly
IVF 25% Dextrose if GRBS is more than 150 mg/dl.
