1. 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

2. 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

3. 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

4. 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

5. 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

6. 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.

7. 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 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

8. DISCHARGE:-
1. Tab. Gluconorm sr – 500mg
2.tab. Desatax xl – 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.

9. THANK YOU