50 YR OLD FEMALE PRESENTING WITH LEFT LOWER BACK PAIN AND VOMITINGS
E LOG GENERAL MEDICINE
Hi, I am Rishitha, 5th Sem Medical Student. This is an online e-log book to discuss our patient's health data shared after taking his/her/guardian's consent . This also reflects patient centered care and online learning portfolio.
This E-log book also reflects my patient-centered online learning portfolio and of course, your valuable inputs and feedbacks are most welcome through the comments box provided at the very end. HAPPY READING!
CASE SHEET
This is a case of 50 year old female who came with chief complains of left lower back pain and vomitings from morning.
CHIEF COMPLAINTS
- Lower back pain on the left side from morning 4 am.
- Vomitings from morning
- Constipation since 3 days
Date of admission : 22.07.2022
HISTORY OF PRESENT ILLNESS- Patient was asymptotic 13 years back which when she had complaints of generalised weakness, polyuria ,blurring of vision followed by unconsciousness for which she was taken to hospital.
- There she was diagnosed with diabetes for which she was given insulin injection and has been taking the injection on daily basis.
- But again, One and half yr back she developed polyuria , incidents of closing of eyes , weakness for which she went to hospital and the doctor had prescribed medication along with injection
- Again, 15 days back she hit her head to the fridge and had developed one side headache .
- She was bought to our hospital complaining about polyuria , headache and also loss of consious for which she was diagnosed with DKA (diabetic keto acidosis) and was treated for the same .
- After one day stay at home , the next day at morning 4 am she had developed pain on her left loin which she complained about it radiating to the back .
- The pain was described as to the dragging type of pain.
- She was then admitted in our hospital on 22 july .
- She also had developed low grade fever associated with chills which relieved on medication.
- She had two episodes of non projectile and non bilious type of vomiting , contents which included food and milk.
- She also had constipation since three days and complaints of irregular bowel movements since 3 months now, describing that hard stools with blood was seen sometimes.
HISTORY OF PAST ILLNESS- No h/o chest pain / giddiness/ syncope/ cough
- K/c/a DKA since 15 days.
- k/c/o of Diabetes Mellitus since 13 yrs
- No history of hypertension , asthma , seizures , TB , CAD
DAILY ROUTINE
- she is a housewife, wakes up at 5 o clock in the morning.
- She does her morning routine and household chores and has her breakfast at 10 am
- She the takes rest and then has her lunch at 2 pm and relaxes and has her evening snacks and night dinner at 9 o clock she sleeps by 10 pm.
PERSONAL HISTORY.
- Appetite is Reduced
- Diet - Vegetarian
- Bowels - Irregular
- Micturition - Increased Frequency (Polyuria)
- Allergic to Chanaga pappu (Chana Dal)
- No habits or addictions.
FAMILY HISTORY
Father is known case of Diabetes
TREATMENT HISTORY- Hysterectomy done 13 years back.
- Insulin injections from 13 years.
- Diabetic medication from One and half year.
OBSTETRIC HISTORY
- 3 children
- 3 gravida 3 para 3 live
- One boy and two girls
Physical Examination Pallor: - Seen.
Icterus: - Not Seen
Cyanosis - Not seen
Clubbing - Not seen
Lymphadenopathy - Not seen
Edema of foot - Not Seen
VITALS :
- Temperature – febrile
- Pulse rate –124 per min
- BP –160/80 mm of hg
- Respiration rate –24
- GRBS – 327
- SPO - 98 percent
SYSTEMIC EXAMINATION
1. CVS - No Thrills
- Cardiac sounds S1,S2
- No murmurs
2. RESPIRATORY
- Dyspnoea - absent
- Wheeze - absent
- Position of trachea - central
- Breath sounds are vesicular
3. ABDOMINAL EXAMINATION
- Abdomen - scaphoid shape
- Tenderness present left loin
- No palpable mass
- Hernial orifices normal
- free fluid absent
- No bruits
- Liver is not palpable
- Spleen is not palpable
- Bowel sounds heard
4. CNS - Conscious, coherent and cohesive.
- Speech is normal
- Signs of meningeal irritation- no neck stiffness
- No kernigs Investigations ordered
INVESTIGATIONS
2D Echo
Blood culture
14/7/2022
15/7/2022
16/7/2022
USG
ECG
MONITORING
PROVISIONAL DIAGNOSIS
Diabetic keto acidosis secondary to sepsis caused by bilateral pyelonephritis
TREATMENT
1) normal diabetic diet
2)inj HAI
3) inj NPH
4) inj meropenam 1gm/ ml / BD
5) TAB nitrofurontion
6) IVF NS and RL 75 ml / hr
7) inj neomol 100ml
8) Tab naxdom250 mg
9) Tab orofer
10) TAb b - complex
11) vital monitoring
same case has been reviewed by one of my classmates. Here is the link https://tejaswienduri.blogspot.com/2022/07/acute-pyleonephritis-on-dka.html
QUESTIONS
1. Why are diabetics more probe to infections, likely UTIs?
A. Diabetics have an increased production of AGE’s which are a results of non enzymatic reaction between reducing sugars and proteins
These AGE’s are likely to enhance the adherence of microorganisms to the bladder due to accumulation of AGE’s on urothelial surface proteins.
Reference: httpsq://pubmed.ncbi.nlm.nih.gov/25986378/
2. Prevalence of pyelonephritis in diabetics compared to non diabetics?
A. The prevalence of pyelonephritis is significantly higher in diabetics than in non-diabetic subjects, with E. coli being the most common isolate.
Elevated glycosylated hemoglobin (HbA1c) predisposes diabetics to UTI. Investigation of bacteriuria in diabetic patients for urinary tract infection is important for treatment and prevention of renal complications.
Reference : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920469/
Hi, I am Rishitha, 5th Sem Medical Student. This is an online e-log book to discuss our patient's health data shared after taking his/her/guardian's consent . This also reflects patient centered care and online learning portfolio.
This E-log book also reflects my patient-centered online learning portfolio and of course, your valuable inputs and feedbacks are most welcome through the comments box provided at the very end. HAPPY READING!
CASE SHEET
This is a case of 50 year old female who came with chief complains of left lower back pain and vomitings from morning.
CHIEF COMPLAINTS
- Lower back pain on the left side from morning 4 am.
- Vomitings from morning
- Constipation since 3 days
- Patient was asymptotic 13 years back which when she had complaints of generalised weakness, polyuria ,blurring of vision followed by unconsciousness for which she was taken to hospital.
- There she was diagnosed with diabetes for which she was given insulin injection and has been taking the injection on daily basis.
- But again, One and half yr back she developed polyuria , incidents of closing of eyes , weakness for which she went to hospital and the doctor had prescribed medication along with injection
- Again, 15 days back she hit her head to the fridge and had developed one side headache .
- She was bought to our hospital complaining about polyuria , headache and also loss of consious for which she was diagnosed with DKA (diabetic keto acidosis) and was treated for the same .
- After one day stay at home , the next day at morning 4 am she had developed pain on her left loin which she complained about it radiating to the back .
- The pain was described as to the dragging type of pain.
- She was then admitted in our hospital on 22 july .
- She also had developed low grade fever associated with chills which relieved on medication.
- She had two episodes of non projectile and non bilious type of vomiting , contents which included food and milk.
- She also had constipation since three days and complaints of irregular bowel movements since 3 months now, describing that hard stools with blood was seen sometimes.
- No h/o chest pain / giddiness/ syncope/ cough
- K/c/a DKA since 15 days.
- k/c/o of Diabetes Mellitus since 13 yrs
- No history of hypertension , asthma , seizures , TB , CAD
- she is a housewife, wakes up at 5 o clock in the morning.
- She does her morning routine and household chores and has her breakfast at 10 am
- She the takes rest and then has her lunch at 2 pm and relaxes and has her evening snacks and night dinner at 9 o clock she sleeps by 10 pm.
- Appetite is Reduced
- Diet - Vegetarian
- Bowels - Irregular
- Micturition - Increased Frequency (Polyuria)
- Allergic to Chanaga pappu (Chana Dal)
- No habits or addictions.
- Hysterectomy done 13 years back.
- Insulin injections from 13 years.
- Diabetic medication from One and half year.
- 3 children
- 3 gravida 3 para 3 live
- One boy and two girls
Pallor: - Seen.
Icterus: - Not Seen
Cyanosis - Not seen
Clubbing - Not seen
Lymphadenopathy - Not seen
Edema of foot - Not Seen
- Temperature – febrile
- Pulse rate –124 per min
- BP –160/80 mm of hg
- Respiration rate –24
- GRBS – 327
- SPO - 98 percent
- No Thrills
- Cardiac sounds S1,S2
- No murmurs
- Dyspnoea - absent
- Wheeze - absent
- Position of trachea - central
- Breath sounds are vesicular
- Abdomen - scaphoid shape
- Tenderness present left loin
- No palpable mass
- Hernial orifices normal
- free fluid absent
- No bruits
- Liver is not palpable
- Spleen is not palpable
- Bowel sounds heard
- Conscious, coherent and cohesive.
- Speech is normal
- Signs of meningeal irritation- no neck stiffness
- No kernigs Investigations ordered
1) normal diabetic diet
2)inj HAI
3) inj NPH
4) inj meropenam 1gm/ ml / BD
5) TAB nitrofurontion
6) IVF NS and RL 75 ml / hr
7) inj neomol 100ml
8) Tab naxdom250 mg
9) Tab orofer
10) TAb b - complex
11) vital monitoring
same case has been reviewed by one of my classmates. Here is the link https://tejaswienduri.blogspot.com/2022/07/acute-pyleonephritis-on-dka.html
QUESTIONS
1. Why are diabetics more probe to infections, likely UTIs?
A. Diabetics have an increased production of AGE’s which are a results of non enzymatic reaction between reducing sugars and proteins
These AGE’s are likely to enhance the adherence of microorganisms to the bladder due to accumulation of AGE’s on urothelial surface proteins.
Reference: httpsq://pubmed.ncbi.nlm.nih.gov/25986378/
2. Prevalence of pyelonephritis in diabetics compared to non diabetics?
A. The prevalence of pyelonephritis is significantly higher in diabetics than in non-diabetic subjects, with E. coli being the most common isolate.
Elevated glycosylated hemoglobin (HbA1c) predisposes diabetics to UTI. Investigation of bacteriuria in diabetic patients for urinary tract infection is important for treatment and prevention of renal complications.
Reference : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920469/
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