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Case 2 Presentation  Diagnosis Young Non-obese Saudi female presenting with sever abdominal pain History Examination Risk factors Investigations Update.

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Presentation on theme: "Case 2 Presentation  Diagnosis Young Non-obese Saudi female presenting with sever abdominal pain History Examination Risk factors Investigations Update."— Presentation transcript:

1 Case 2 Presentation  Diagnosis Young Non-obese Saudi female presenting with sever abdominal pain History Examination Risk factors Investigations Update

2 CASE History 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.

3 Examination Pulse is 100/minBP: 130/70 Resp. rate is 34/ minTemp: 36 °C Weight: 71 KgmHeight: 167 BMI:25.4 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 CASE

4 Investigations WBC21.4T. Bilirubin9 RBC4.9T. Protein74 HGB14.0Albumin40 HCT42.9Alk. Phosphatase59 PLT443Alanine Aminotrasf16 DIFNormalAspartate Aminotransf23 ESTNAGamma GT9 Urea2.5Sodium139 Creatinine86Potassium2.1 Paracetamol79.2 ug/ml( 0 - 9.9 ) Glucose21.7 CASE

5 Problem list: CASE Hyperglycemia. Hypokalemia. Leukocytosis. Drug over dose.

6 Problem list: CASE Hyperglycemia: Diabetes Mellitus. Sampling error. Lab. Error. Pancreatitis. Factitious. Hypokalemia: Diabetes Mellitus. Drugs…… diuretics. Leukocytosis: Infection. Inflammatory process. Demargenation. Leukemia. Others. Drug over dose: Paracetamol. Dusputalin.

7 ? Diabetes Keto-Acidosis Blood gases: PH7.4 PCO 2 20.3 PO 2 153.5 O 2 saturation99 Bicarbonate12.8 Total CO 2 13.5 Urine analysis: Ph 5 Glucose-ve Ketones-ve Protein -ve WBC-ve Culture-ve Others: ECGN Chest x-rayN PT12.9 PTT32.4 Glucose21.7 CASE

8 Precipitating factors for DKA: Handbook of Diabetes 2nd edition 1992     CASE

9 Up date CASE

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