DIABETIC KETOACIDOSIS SCENARIO:- here is a 56yrs old female hospitalized for 6 days PATIENT DEMOGRAPHICS:- NAME:- AGE:- 56yrs GENDER:- female PRESENTING COMPLAINTS:- c/o fever since 8 days c/o pain in abdomen since 7 days c/o vomiting and burning micturition since 5 days HISTORY OF PRESENTING ILLNESS:- patient was apparently normal 8 days back but developed fever which was insidious in onset. Pain in abdomen since 7 days and vomiting containing food particles and burning micturition since 5 days. PAST MEDICAL HISTORY:- k/c/o, diabetes mellitus since 20 years. PAST MEDICATION HISTORY:- tab. Gluconorm-sr 500mg

LABORATORY INVESTIGATIONS:- DATE 28/2 1/3 2/3 3/3 4/3 5/3 GRBS mg/dl 294 163 116 170 150 126 Glycosylated Hb A1C 11% TLC 14,500 cumm Neutrophils 83 Eosinophils 7 ESR 110mm/hr Hb 9.8% Urine PUS cells 4-6 cells Ketone bodies + ve

GENERAL PHYSICAL EXAMINATION:- Palpation- soft mild tenderness in the abdomen No organomegaly Pallor present SOAP NOTE SUBJECTIVE:- Here is a 57 yrs old female patient with complaints of fever since 8 days, pain in abdomen since 7 days, vomiting and burning micturition since 5 days. OBJECTIVE:- GRBS is increased 294 mg/dl – indicates hyperglycaemia -diabetes mellitus Glycosylated HbA1C is 11% it indicates poor diabetic control Ketone bodies test is positive which indicates diabetic ketoacidosis

TLC is increased – 14,500 cumm – which is an indication of infection Eosinophils are increased – 7 – which is an indicative of infection Neutrophils are increased -83- which is an indicative of infection. ESR is increased 110 mm/hr – which is an indicative of infection Hb is 9.8% decreased – which indicates anemia Urine – pus cells are increased 4-6 cells – which indicates infection. DIAGNOSIS:- By assessing the subjective and objective evidences the patient was diagnosed with diabetic ketoacidosis. ASSESSMENT:- PROBLEM LIST- 1. FEVER 2. PAIN IN ABDOMEN

3. VOMITING 4. BURNING MICTURITION 5. DIABETIC KETOACIDOSIS Fever:- due to release of ketone bodies in blood, this causes metabolic acidosis, the thermoregulatory mechanism of the body is altered and hyperpyrexia occurs. Pain in abdomen:- due to ketoacidosis dehydration and hyperosmolarity occurs causing anorexia and pain in abdomen Vomiting:- ketones stimulate the vomiting center and cause vomiting and dehydration Burning micturition:- due to metabolic acidosis, there will be release of ketone bodies in the urine and burning sensation while micturition. Diabetic ketoacidosis:- due to lack of insulin, the lipolysis effect is

Removed and non-esterified fatty acids are released into blood and taken up by liver and produces ketone bodies – acetoacetate and ß hydroxy butyrate. S.NO PROBLEM GOALS OF THERAPY DRUGS AND MOA DOSAGE 1. DIABETIC KETOACIDOSIS To reduce the symptoms of ketoacidosis To prevent reoccurance of ketoacidosis Insulin – In insulin deficiency external insulin supplement is supplied. Insulin converts glucose into glycogen and stored in the liver. Metformin – It enhances insulin sensitivity and promotes uptake of glucose. Depending upon the blood glucose values . 500mg.

S. NO TRADE NAME GENERIC NAME DOSE 28/2 1/3 2/3 3/3 4/3 5/3 1. INJ.CEFERA Ceftriaxone 2gm 1-0-1 * X INJ. RAZO Rabeprazole 20mg 1-0-0 3. INJ. ZOFER Ondansetron 2cc 1-1-1 4. INJ. VOVERAN Diclofenac sodium 75mg s-o-s 5. INJ. LUPISULIN Insulin 8 hourly 6. INJ. ORNI Ornidazole 100ml 1-0-1 7. TAB. DOLO Paracetamol 650mg s-o-s 8. CAP. BENEFICIALE Multi vitamin 100mg 1-0-0 9. CAP. NERVIJEN Methyl cobalamine 10. TAB. GLUCONORM Metformin 500mg 0-1-0 11. TAB. DESATAX Cefexime+ dicloxacillin 1-1-0 12. TAB. RECLIDE gliclazide 40mg 1-0-1

DISCHARGE:- 1. Tab. Gluconorm sr – 500mg 2.tab. Desatax xl – 1-0-1- 5 days 3. tab. Reclide 40mg 1-0-1 4. tab. Razo 20mg 1-0-0 Cap. Nervijen 0-1-0 Follow up after 5 days. PHARMACIST INTERVENTION AND SERVICES :- No drug interactions found PATIENT COUNSELLING:- Gluconorm should be taken 30 mins before food. Rabeprazole should be taken before breakfast. Avoid high carbohydrate containing food. Exercise regularly and check blood glucose levels regularly.

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