Transcript Case 2 Presentation Diagnosis

Young Non-obese Saudi
female presenting with
sever abdominal pain
History
Examination
Risk factors
Investigations
Update
Case 2
Presentation

Diagnosis
M.R is 19 years old Saudi young lady presented to the emergency
room with sever abdominal pain, nausea, and vomiting. She is
known to have irritable bowel syndrome treated with Dusputalin on
PRN bases. She did not have hematemesis or malena and denies
jaundice or fever. She never had similar attach in the past and not
known to have related diseases ( i.e sickle cell disease,….etc ).
Trying to control her sever abdominal pain one hour before her
presentation she toke:
Ten tablets of paracetamol ( 5 gram )
Seven tablets of Dusputalin
She is not known to have diabetes and no family history of chronic
diseases. Her past history was unremarkable and she is not taking
any medications other than what is mentioned above.
Non-smoker or alcoholic, university student.
History
CASE
Irritable, agitated, and sweating. Not pale or
jaundiced or cyanosed but had fine tremor
bilaterally.
No goiter and normal eye and skin exam.
CVS: systolic murmur I / VI but normal heart
sounds and JVP.
Chest: Hyperventilating but normal breath sounds.
Abdm: Soft, no tenderness or guarding or rigidity.
No organomigaly, with normal bowel sounds.
CNS: Unremarkable
Examination
Pulse is 100/min
BP: 130/70
Resp. rate is 34/ min
Temp: 36 °C
Weight: 71 Kgm
Height: 167
BMI:25.4
CASE
WBC
RBC
HGB
HCT
PLT
DIF
EST
21.4
4.9
14.0
42.9
443
Normal
NA
T. Bilirubin
T. Protein
Albumin
Alk. Phosphatase
Alanine Aminotrasf
Aspartate Aminotransf
Gamma GT
9
74
40
59
16
23
9
Urea
Creatinine
2.5
86
Sodium
Potassium
139
2.1
Paracetamol
Glucose
Investigations
79.2 ug/ml21.7 ( 0 - 9.9 )
CASE
Problem list:
• Hyperglycemia.
• Hypokalemia.
• Leukocytosis.
WBC
RBC
HGB
HCT
PLT
DIF
EST
21.4
4.9
14.0
42.9
443
Normal
NA
T. Bilirubin
T. Protein
Albumin
Alk. Phosphatase
Alanine Aminotrasf
Aspartate Aminotransf
Gamma GT
9
74
40
59
16
23
9
Urea
Creatinine
2.5
86
Sodium
Potassium
139
2.1
Glucose
Paracetamol
• Drug over dose.
21.7
79.2 ug/ml
( 0 - 9.9 )
Investigations
CASE
Problem list:
Hyperglycemia:
Leukocytosis:
Hypokalemia:
• Diabetes
Mellitus.
Drug over
dose:
• Infection.
• •Sampling
error.
Diabetes
Mellitus.
•
Inflammatory
process.
• Lab.
Error.
• Paracetamol.
• Demargenation.
• •Pancreatitis.
Drugs……
diuretics.
•
Leukemia.
• Factitious.
• Dusputalin.
• Others.
CASE
? Diabetes Keto-Acidosis
Blood gases:
Urine analysis:
Others:
PH
PCO2
PO2
O2 saturation
Bicarbonate
Total CO2
Ph
Glucose
Ketones
Protein
WBC
Culture
ECG
Chest x-ray
N
N
PT
PTT
12.9
32.4
7.4
20.3
153.5
99
12.8
13.5
Glucose
5
-ve
-ve
-ve
-ve
-ve
21.7
CASE
Precipitating factors for DKA:
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
Handbook of Diabetes 2nd edition 1992
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CASE
Up date
CASE