A 27 yr old male presented to casuality with left sided chest pain since 10 days worsening since yesterday night
HOPI :
Pt was apparently asymptomatic 15 days then he developed fever after spraying pesticides in field ,associated with cough with expectoration
Pt was taken to a local doctor and treated symptomatically , but symptoms not relieved
Pt developed left sided chest pain 10 days back ,non radiating ,diffuse pain ,pain increased on inspiration
Not a/w sweating, palpitations
pt was refered to our hospital in view of persistent fever ,cough with chest pain
PAST HISTORY :
No h/o HTN,epilepsy,TB,asthma
PERSONAL HISTORY :
Appetite -normal
Diet mixed
Bowel and bladder- regular
Sleep adequate
Addictions - occasionally takes alcohol 250 ml a week from 5 years
Has a habit of tobacco chewing from 5 years
FAMILY HISTORY
Not significant
GENERAL EXAMINATION
O/E pt is c,c,c
Moderately built
No pallor ,icterus, cyanosis, clubbing, lymphadenopathy ,edema of feet
Vitals :
Temp : 100.6
Bp :110/70
PR: 111
Rr: 22
Spo2: 97
GRBS:373mg/dl
RS:
Inspection : shape of chest : normal
⁃ Symmetry of chest : symmetrical
⁃ No visible scars , no sinuses , no engorged veins
⁃ No deformities of spine
⁃ No visible apical impulse
Palpation:
-No tenderness and no local rise of temperature
⁃ Inspectory findings are confirmed
⁃ Trachea central
⁃ Apex beat : felt at 5 th Intercoastal space medial to mid clavicular line
- vocal fremitus
Percussion :
Auscultation:
-B/L Air entry pesent
-Left side inspiratory crepts in IMA,IAA
- Aegophony
Cvs : s1 s2 heard ,no murmurs
CNS: NAD
PA : soft , non tender ,no organomegaly
INVESTIGATIONS:
PROVISIONAL Diagnosis : DIABETIC KETOACIDOSIS WITH
? LEFT LOBE PNEUMONIA
WITH DENOVO TYPE 1 DM
TREATMENT
1) IVF-NS @100ml /hr
2) INJ. HAI INFUSION @4ml/hr
3)INJ PAN 40mg iv /od
4)INJ ZOFER 4 mg iv/sos
5)INJ NEOMAL 1gm iv/sos
6)TAB PCM 650mg /po/sos
Day 1
27 M with c/0 chest pain since 3 days;cough with expectoration (hemoptysis)since 2 days and high grade fever since 2 days.
SOB grade 2-3 since 2 days.
O
Bp-120/70
Pr-116
Cvs-s1s2 heard
Rs-BAE present
Left-MA,IAA,ISA-coarse crepts present and decreased air entry
Temp-101f
GRBS-90mg/dl(Hai@1ml/hr)
A-DKA
Left lower lobe pneumonia
Denovo detected type 1DM
P-continue insulin infusion till acidosis resolved.
Plan to bridge to subcutaneous insulin
DAY 2
S - patient stillcomplainof cough and hemoptysis and SOB on exertion
Day 3
S - cough decreased ,1 fever spikes yesterday ,chest pain subsidied appetite improved
Day 4