Case history
20yr Old female came to OPD with Pain Abdomen
April.01.2022
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20 year old female student by occupation came with the chief complaints of abdominal pain since yesterday morning 7:00 am.
History of 3 episodes of vomiting present( bilious in content non projectile).
Chief complaints of pain abdomen in epigastric region insidious in onset gradually progressive in nature associated with vomitings.
Patient was apparently asymtomatic 3 years back, met with an RTA and was admitted in hospital and diagnosed with Diabetes type 1 and was on Insulin subcutaneous
Patient was alright till 8 months back then she had epigastric pain radiating to back insidious in onset and was diagnosed with acute pancreatitis and was on conservative management till then.
After 10 days, she developed hyperpigmented spots and patches on her lower back and lower limbs for which she consulted the doctor several times but they did not resolve.
Non alcoholic , Non smoker.
GENERAL EXAMINATION
NO Pallor , Icterus , Cyanosis , Clubbing ,lymphadenopathy.
Vitals
Temp - afebrile
BP - 120/100 mm hg
PR - 120 bpm.
RR - 19 cpm
spo2 100 @RA
GRBS - 259 mg/dl @ 3 Pm
CVS - S1, S2 heard
RS : bae present
P/A : soft , tender , Guarding Present
CNS : NA
Dermatologist Referral has been taken i/v/o pigmentation over B/L legs
O/E :- Multiple polysized, well-defined, scaly
annular plaque noted all over buttocks, groins, both legs, face.
∆ : Tinea Corporiset Cruris
Rx : Lulifin lotion all over the body / LA /BD x 2 weeks
INVESTIGATION
On 24/03/2022
Serum Lipase - 135
Serum Amylase - 261
On 28/03/2022
Serum Lipase - 36
Serum Amylase - 69
RBS - 292 mg/dl
Urine Protein/Creatinine Ratio :
Spot urine protein : 45.7 mg/dl
Spot urine creatinine : 83mg/dl
Ratio : 0.55
Sickling Test on 27/03/22 - Negative
Rapid Dengue 27/02/22 - Negative
Serum Lipid Profile On 22/3/22
Total Cholesterol - 486mg/dl
TRIGLYCERIDES - 1128 mg/dl
Serum Lipid Profile on 24/03/2022
Total Cholesterol - 261
Triglycerides - #932
HDL Cholesterol - #81
LDL Cholesterol - # 150
Serum Lipid Profile on 29/03/2022
Total Cholesterol - 229
Triglycerides - 563
HDL Cholesterol - 60.9
LDL Cholesterol - 137.5
HAEMOGRAM 23/03/2022
Haemoglobin - 13 gm/dl
Total Count - 13,200
RBC - 5.46
Platelet Count - 3.36 lakh
HAEMOGRAM 27/03/2022
Haemoglobin - 11.7 gm/dl
Total Count - 8,300
RBC - 4.87
Platelet Count - 3.68 lakh
RFT
S Urea - 29
S Creatinine - 0.7
Uric acid - 8.8
S Calcium - 10.2
Na - 137
K - 4.5
Cl - 98
LFT
Total Bilirubin - 1.52
Direct Bilirubin - 0.62
Ast - 17
Alt - 9
Alk P - 181
Total Protein - 6.8
Albumin - 3.37
A/G - 0.98
CRP -
HbA1c - 6.9 %
Serology -
ECG
2D Echo
Chest Xray PA View
USG Abdomen
CECT ABDOMEN
DIAGNOSIS
Acute Pancreatitis with DKA with Type 1 Diabetes Mellitus ( since 3 year)
TREATMENT
1. Nbm till further orders.
2. IVF- NS & RL @ 150ml/hr.
3. Inj HAI ( 39ml Normal Saline + 40 IU HAI ) @ 4 ml / hr according to Algorithm
4. Inj. Pantop 40mg/IV/OD.
5. Inj. Zofer 4mg/IV/OD.
6. Inj. Tramadol 1amp in 100 ml/NS/IV/BD.
7. Inj. THIAMINE 2amp in 1 NS/IV/TID.
8. Monitor vitals.
9. Measure abdominal girth.
