CLERKSHIP

PRESENTATION
Presented by: D.Ruchitha
Roll No: 19Z51T0004
Geethanjali college of pharmacy
CASE
A CASE STUDY OF 20 YEAR OLD MALE
PATIENT ADMITTED IN HOSPITAL WITH
CHIEF COMPLAINTS OF FEVER,
VOMITINGS, HURRIED RESPIRATION AND
ABDOMINAL DISTRESS K/C/O TYPE1 DM
DIAGNOSED AS DIABETIC KETOACIDOSIS
 AN OVERVIEW OF 3

DKA
Diabetic ketoacidosis is a serious complication of diabetes
that occurs when your body produces high levels of blood
acids called ketones.
The condition develops when your body can't produce
enough insulin. Insulin helps in entry of glucose into cells
and tissues to release energy.
Without enough insulin, the body begins to break down fat as
fuel. This process produces a buildup of acids in the
bloodstream called ketones, eventually leading to diabetic
ketoacidosis if untreated.
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CLINICAL MANIFESTATIONS
• Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes
within 24 hours.
• Excessive thirst
• Frequent urination
• Nausea and vomiting
• Stomach pain
• Weakness or fatigue
• Shortness of breath
• Fruity-scented breath(Kussmaul breathing is an abnormal breathing pattern
characterized by rapid, deep breathing at a consistent pace. It's a sign of a medical
emergency — usually diabetes-related ketoacidosis (DKA))
• Confusion
CASE: 230XXXXX82
DIABETIC KETOACIDOSIS (K/C/O TYPE1 DM)
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CASE
• 20 YEAR OLD MALE PATIENT

• CHIEF COMPLAINTS: vomiting, fever, generalized weakness, hurried

respiration, and abdominal distress since yesterday.

• Reg. Number SP001XXXX

Gender Male
Age 20 years
Ethnicity -
DOA 03/09/023
DOD 08/09/023
Patient admitted in hospital (Y).
 PAST MEDICAL HISTORY
PMHX: KNOWN CASE OF TYPE-1 DIABETES MELLITUS.
8

PAST MEDICATION HISTORY

PMHX: WAS ON MEDICATION, INJ. INSULIN - 6
UNITS-TID.

ALLERGIES
NIL KNOWN ALLERGIES.

FAMILY HISTORY FHX : FATHER HAS TYPE1 DM WAS ON MEDICATION,

INJ. INSULIN.

SOCIAL HISTORY

SHX : COLLEGE STUDENT, HAS THE HABIT OF

EATING FAST FOODS, OFTEN MISSES THE
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REVIEW OF SYSTEM 9

DAYS 1 2 3 4 5 and 6

O/E GC fair, febrile GC fair, Afebrile GC fair GC fair, GC fair, Afebrile

Afebrile

PULSE 79bpm 83bpm 82bpm 82bpm 82bpm

BP 110/70 120/70 100/70 110/70 110/70

H/L NAD NAD NAD NAD NAD

ABDOMEN Soft Soft Soft Soft Soft

CHEST Bilateral air entry Bilateral air entry Bilateral air Bilateral air Bilateral air entry
entry entry
SKIN Moist, no rash Moist, no rash Moist, no rash Moist, no rash Moist, no rash

ADVICE RBS, PLBS, Urine for FBS, PLBS, urine for FBS, PLBS FBS, PLBS
ketone bodies ketone bodies
 LAB INVESTIGATIONS
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DAYS TESTS DONE NORMAL RANGE TEST RESULT

DAY 1 KETONE BODIES +ve

RBS (140-159 mg/Dl) @1:30pm – 322mg/dL

@ 9:00pm – 562mg/dL

DAY 2 KETONE BODIES +ve

FBS (80- 100 mg/dL) 282mg/dL

PLBS (<120 mg/dL) 468 mg/dL

DAY 4 FBS (80- 100 mg/dL) 291 mg/dL

PLBS (<120 mg/dL) 385 mg/dL

 VITALS 11

Vital Signs 1 2 3 4

Temperature 37 37 37.5 37

Respiratory rate 30 33 32 34

Heart rate 102 100 97 90

SPO2 97% 97% 100% 95%

Blood Pressure Chart SBP

160
150 SBP
140
130

Blood Pressure
120
110
100
90
80
DBP
70
60
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INITIAL MANAGEMENT

PLAN INITIAL MANAGEMENT DISCHARGE

• Plan: To control random • Discharge medications given

blood sugar levels • proceed to insulin therapy along with fixed dose of
immediately as it lead to along with electrolytes as it a insulin
DKA standard treatment
• Along with insulin therapy
broad spectrum antibiotics
are also advised
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PROGRESS NOTE 13

DATE DAY OBJECTIVE/ DRUG NAME FREQUENCY

ASSESSMENT
03/09 1 No complaints Inj. Ceftriaxone 1-0-1
Inj. Pantaprazole 1-0-1
Tab. Paracetamol 1-1-1
Cap. Multivitamin 0-1-0
Inj. Human Act Rapid 1-1-1
04/09 2 No complaints CST and CST
Inj. Human Act Rapid (10U) 10-10-10U
05/09 3 CST and
ADD: IVF NS (2pints) For 4 days
IVF RL (1pint) For 4 days
Inj. HAR (15U) 15-15-15U
06/09 4 No complaints CST and
Inj. Human Act Rapid (20U) 20-20-20U
07/09 5 No complaints CST CST

08/09 6 No complaints CST CST

 INITIAL MANAGEMENT
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• As the patient is in febrile condition start with

S.n Drug name Generic name R/ Dose Therapeutic use Potential ADRs Monitoring
o O parameter
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1 Wellceft Inj. Ceftriaxone IV 1g Antibiotic- used to treat bacterial Black, tarry stools Alterations
infections in prothrombin times

2 Pan 40 Inj. Pantaprazole IV 40mg Antacid Hypocalcemia, gas, Monitor bone loss,
joint pain fractures,
Clostridium difficile-
associated diarrhoea
(CDAD)
3 Dolo Tab. Paracetamol PO 650 Anti pyretic nausea, vomiting, Monitor liver
mg constipation function tests
4 Multivitami Cap. Multivitamin PO - Vitamin and mineral supplement - -
n

5 - Inj. Human Act rapid SC Reduces blood sugar level Hypoglycaemia Regular blood
insulin sugar monitoring

6 IVF NS Sodium chloride inj, IV 2 pints Electrolyte replenisher - -

7 IVF RL Sodium lactate (ringer’s IV 1 pint Electrolyte replenisher - -

lactate)
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PHARMACEUTICAL
CARE ISSUES

PCI:
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SUMMARY
20 YEAR OLD MALE PATIENT ADMITTED IN HOSPITAL WITH
CHIEF COMPLAINTS OF FEVER, VOMITINGS, HURRIED
RESPIRATION AND ABDOMINAL DISTRESS K/C/O TYPE1 DM

DIAGNOSED AS DIABETIC KETOACIDOSIS

PROVIDED WITH INSULIN THERAPY

THANK YOU