Case Presentation

By :
I Wayan Arya Prayoga
19710070

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Internal Medicine Department
RSUD Sidoarjo
University of Wijaya Kusuma
 Name : Mrs. S
 Age : 53 years old
 Address : Kendo, Candi, Sidoarjo
 MR No. : 2038038
 Job : Housewive
 Marital Status : Married
 Date of hospitalized : 21 January 2020

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 20 January 2020, 23.00 WIB
 Triage  Yellow ( level 4 )
 Mental status  Alert
 Major Complaint :
Loose and watery stools

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History of the present illness

 This condition has been started around 3 days prior to

admission into the hospital.
 In the last 24 hours, patient had more than 10 stools with
watery consistency, brown colored stools with mucus (+),
every stools are around 200-400 cc in volume.
 Nausea (+) and Vomiting (+) Unable to tolerate oral intake.
 Acute abdominal pain
 Poliuria followed with weight loss
 Fatigue and weakness of the body also occurred and made
the condition became worse.

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 Past History :
 Diabetes (+)
 Hypertension (+)
 Stroke (+)

 Family history
 Irrelevant

 Social history
 Low social economic status

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 General appearance :
 The patient was fully conscious, alert, looks ill, and weak.

 Vital Sign :
 Blood pressure : 120/80 mmHg
 Pulse : 88 b/minutes (radialis), regular
 Temp : 36.7o C
 RR : 22 c/minutes

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 Head & Neck

 A/I/C/D -/-/-/-
 Sunken Eyes (+)
 No lateralization of trachea
 No enlarged thyroid gland
 No congested neck veins
 No lymphadenopathy

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 Chest :
 Bilateral equal air entry

 Heart :
 Murmur (-) Gallop (-)

 Abdomen
 Increased turgor ( 4-5 second ), no organomegaly or ascites

 Extremities :
 Warm, red and dry in all extremity, sign of shock (-)
 Normal capillary refill time
 No joint swelling, tenderness or limitation of movement
 Motor power & deep reflexes were normal
 No abnormal sensory deficit

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 Blood Cell Count :
 Blood Glucose : 281 mg/dL

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1. Watery stools
2. Nausea and vomiting
3. Abdominal pain
4. Fatigue and weakness

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Hiperglikemic Diabetes Mellitus + Acute
Gastroenteritis with Mild Dehidration

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 P. Dx :
 Complete Blood Count ( CBC )
 Complete Urinalysis
 Blood Glucose

 Tx :
 Inf Ringer Lactate 1000cc/24hours
 Inj Santagesic 3 x 1g
 Inj Ondancentron 3 x 8mg
 Inj Ranitidine 2 x 40mg
 Inj Novorapid 3 x 4 IU
 P.o Pullarex 2 tabs/diarrhea

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 What is Diabetes Mellitus ?
 What is Acute Gastroenteritis ?
 Does Diabetes Mellitus has any conjunction with Diarrhea ?

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 Diabetes mellitus (DM) is a metabolic disorder characterized by
chronic hyperglycaemia due to defects in insulin secretion and/or
insulin action.
Diabetes can be associated with classical symptoms of
hyperglycemia which include polyuria, polydipsia, polyphagia, and
weight loss. However many people with diabetes can remain
asymptomatic for many years and blood tests are required for
diagnosis.

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 Acute gastroenteritis (AGE) is a diarrheal disease of rapid onset,

with or without accompanying symptoms and signs, such as

nausea, vomiting, fever or abdominal pain. Diarrhea is defined
as three or more loose, watery stools a day.

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It is not uncommon for patients with a gastroenteritis attack to show
abnormal vital signs; fever, tachycardia, and pain can all be present. This
clinical picture includes the following signs and symptoms:
1. Dry membranes,
2. Less turgor of skin,
3. Absent pulsations of the jugular vein,

The clinical picture of dehydration could also present depending on the

severity of the disease.

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 Patients with a longstanding history of diabetes may experience
frequent diarrhea, and this has been reported to occur in up to 22%
of patients. This may be related to problems in the small bowel or
colon. Abnormally rapid transit of fluids may occur in the colon,
leading to increased stool frequency and urgency. In addition,
abnormalities in the absorption and secretion of colonic fluid may
develop, leading to increased stool volume, frequency, and water
content.

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