55 YEAR FEMALE K/C/O OF DM SINCE 3 YEARS ON OHAS WITH C/O GIDDINESS

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Here we discuss our individual patient problems through series of inputs from  available global online community of experts with an aim to solve the patients clinical problem with current best evidence based input.

This E-blog also reflects my patient's centred online learning portfolio.

I have been given this case to solve in an attempt to understand the topic of "Patient Clinical Data Analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.

Case History and Clinical Findings:

55 YEAR FEMALE K/C/O OF DM SINCE 3 YEARS ON OHAS

PATIENT CAME WITH C/O GIDDINESS SINCE YESTERDAY MORNING FOLLOWING

EXOPOSURE TO HEAT AND WENT TO RMP -SBP WAS 70MMHG AND 10 NS GIVEN -AND SHE

DEVELOPED FACIAL PUFFINESS ,PEDAL EDEMA.

C/O LOOSE STOOLS SINCE TODAY 5-6 EPISODES

NO H/O VOMITINGS ,PAIN ABDOMEN

C/O BOWEL AND URINARY INCONTINENCE 4 TIMES SINCE TODAY MORNING .

NO C/O SEIZURES ,HEADACHE.

SOB GRADE 4 SINCE @ 4PM TODAY , PEDAL EDEMA SINCE 1 DAY

UNRESPONSIVE SINCE 15 MINUTES

AT OUTSIDE HOSPITAL ; SERUM CREATININE -2.1, PH-6.7

K/C/O DM SINCE 3 YEARS

VITALS

TEMP-98.6F

PR-110BPM

BP-140/100MMHG

RR-26CPM

SPO2- 29% @ ROOM AIR

GRBS-331MG/DL

NO PALLOR/ICTERUS/CLUBBING/CYANOSIS/LYMPHADENOPATHY

EDEMA PRESENT

CVS-S1,S2 HEARD

RS-BAE PRESENT,DIFFUSE WHEEZE PRESENT

P/A- BOWEL SOUNDS PRESENT

CNS-UNESPONSIVE

GCS-E1V1M1

SPEECH-NO RESPONSE

Diagnosis

IMMEDIATE CAUSE OF DEATH : SEVERE METABOLIC ACIDOSIS WITH TYPE 2 RESPIRATORY

FAILURE

ANTECEDENT CAUSE OF DEATH : ACUTE GASTROENTERITIS WITH AKI ,MIXED ACIDOSIS ,?

HYPERCAPNIC ENCEPHALOPATHY

TREATMENT:

1]INJ LASIX 40MG IV STAT

2]INJ NAHCO3 50 MEQ IV STAT-> 100MEQ +100ML NS OVER 1 HOUR

3]INJ HUMAN ACTRAPID 3C IV STAT

4]NEBULISATION WITH DUOLIN &BUDECORT

DEATH SUMMARY:

55 YEAR OLD FEMALE K/C/O DM SINCE 3 YEARS ON OHAS WITH A/H/O GIDDINESS AND

HYPOTENSION @ OUTSIDE HOSPITAL FOLLOWING WHICH 10 NS GIVEN [NO

DOCUMENTATION AVAILABLE ],AFTER THAT PATIENT DEVELOPED FACIAL PUFFINESS

,PEDAL EDEMA ONE DAY AGO.

C/O LOOSE STOOLS 4-5 EPISODES SINCE 1 DAY ,BOWEL AND URINARY INCONTINENCE 4

TIMES SINCE 1 DAY ,NO C/O SEIZURES ,HEADACHE .

C/O ACUTE SOB GRADE 4 @ AROUND 4PM ON 10/5/22 AND UNRESPONSIVE SINCE 30

MINUTES.AT PRESENTATION PATIENT IS UNRESPONSIVE ,GCS-E1V1M1,SPO2-29@ ROOM

AIR,GRBS -331,BP-140/100MMHG,RR-26CPM.BILATERAL DIFFUSE WHEEZE PRESENT.

INJ LASIX 40MG ,NEBULISATIONS,HEAD END ELEVATION GIVEN ,SPO2 IMPROVED TO 90%

WITH HIGH FLOW 02,ABG WAS DONE WITH HIGH FLOW O2 -PH-6.846,PCO2-106MMHG,PO2-

108,SO2-93.1,HCO3-17.4,STHCO3-11.4,INJ NAHCO3 50MEQ IV STAT GIVEN FOLLOWED BY

100MEQ IN 100ML NS .PATIENT HAD SUDDEN CARDIAC ARREST AT 1.00AM ,CPR STARTED

ACCORDING TOACCS GUIDELINES.AFTER 6 CYCLES OF CPR ROSC ATTAINED ,INTUBATED

AND CONNECTED TO MECHANICAL VENTILATOR .POST INTUBATION BP-NR,STARTED ON

INOTROPES.PATIENT HAD ANOTHER EPISODE OF SUDDEN CARDIAC ARREST @ 1.50AM.

AFTER 7 CYCLES OF CPR ROSC ATTAINED .BP-NR,PR-132BPM.PATIENT HAD ONE MORE

EPISODE OF SUDDEN CARDIAC ARREST AT 2.35AM ,AND 2 CYCLES OF CPR DONE .INSPITE

OF ALL ABOVE EFFORTS PATIENT COULD NOT BE REVIVED AND DECLARED DEAD ON

11/5/22 AT 2.45 AM

IMMEDIATE CAUSE OF DEATH : SUDDEN CARDIAC ARREST SECONDARY METABOLIC TO

SEVERE METABOLIC ACIDOSIS WITH TYPE 2 RESPIRATORY FAILURE

ANTECEDENT CAUSE OF DEATH : ACUTE GASTROENTERITIS WITH AKI ,MIXED ACIDOSIS ,?

HYPERCAPNIC ENCEPHALOPATHY

COMORBIDITIES: DIABETES MELLITUS