50 year old male with DKA

Unit 5 admission 
Interns-
Dr. Shriya Reddy
Dr. Anjali
Dr. Konda Soumya 
Dr. Sreedevi
Dr. Mourya 
Dr. Shashikala pgy1
Dr. Shailesh pgy1
Dr. Zain pgy2
Dr. Natasha pgy3
Dr. Praveen Naik Associate professor
This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 

Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 

This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.
  50 year old male came with complaints of involuntary movements of both upper and lower limbs since morning. GTCS type 
6 episodes since 6:30 am, lasting for 2-3 minutes on an average. Last episode in xray room which lasted for 1 min (less than 1 minute?) associated with tongue bite, involuntary micturition too. Post ictal confusion could not be elucidated as patient was in altered sensorium. 
4 days back he had visual hallucination (said he saw lightening) after which he had an episode of GCTS which wasn't associated with any seizure- -accompanying symptoms (the usual ones which he had today for which he got CT brain done which showed sub-acute infarcts. 
K/c/O DM and HTN since 6 years. Taking glimi-M2 bd and telmisartan 40mg od respectively. 
History of left hemiparesis for which he took Ayurvedic medication. Not a k/c/o asthma, epilepsy, cad any similar systemic illness. Occasional alcoholic, non-non-smoker
Provisional diagnosis-GTCS secondary to epileptic foci? Old infarcts. 
Diabetic Ketoacidosis
Rx-
Day 1
Inj. Levipil 500mg iv bd 
Inj. Actrapid 40units in 39ml NS @6ml/hr.
Propped up position always
IVF NS @125ml/hr and 1/2NS
Inj. Optineuron 1 amp in 100ml NS IV OD
Grbs monitoring every hourly
Vitals monitoring
Day 2 
O/E -
Afebrile
Bp-140/80mmhg
Pr-88bpm
Rr-19cpm
Input-2700ml output-2650ml 
Grbs-168mg/dl
Cvs-s1s2
Pa-soft non tender
Rs-bae+ nvbs
Rx
Inj. Levipil 500mg iv bd 
IVF 1/2NS @125 ml/hr
Inj. Optineuron 1 amp in 100ml NS IV OD
Inj. Monocef 1gm IV bd
Inj. H. Actrapid IV sos
Propped up position 
Vitals monitoring
Grbs monitoring every hourly
Rules tube and free water 200ml every hour 
Inj thiamine 100mg in 100ml NS IV tid
Day 3no fresh complaints
-patient is conscious ,coherent, cooperative
Temp - 98.6 F 
BP - 130/ 80 mmhg
PR - 94 bpm 
CVS - S1S2 heard , no murmurs
RS- NVBS Present , no crepts
GRBS -153 , 6 units given
I/O - 3900/2300 ml
GTCS secondary to epilepticfociwith old infarcts with diabetic ketoacidosis
Plan 1.Inj.LEVIPIL 500 mg / Iv / BD 
2.IVF 1/2 NS  @ 125 ML / HR
3. INJ .OPTINEURON 1 AMP IN 100 ML/ 1NS/IV / OD
4.INJ .THIAMINE IN 100 MLNS / IV / TID
5. INJ.MONOCEF1 GM / IV / BD 
6.INJ H.ACTRAPID / IV / SOS
7.propped up position 
8.vitals montoring 
9. GRBS monitoring 2nd hourly
10.INJ .HAI According to s/ s
Day 4
patient is conscious ,coherent, cooperative
Temp - 98.1 F 
BP - 130/ 80 mmhg
PR - 96 bpm 
CVS - S1S2 heard , no murmurs
RS- NVBS Present , no crepts
GRBS -229 , 6 units given
I/O - 2900/2300 ml
GTCS secondary to epileptic fociwith old infarcts with diabetic ketoacidosis
Plan 1.Inj.LEVIPIL 500 mg / Iv / BD 
2.IVF 1/2 NS  @ 75 ML / HR
3. INJ .OPTINEURON 1 AMP IN 100 ML/ 1NS/IV / OD
4.INJ .THIAMINE IN 100 MLNS / IV / TID
5. INJ.MONOCEF1 GM / IV / BD 
6.tab.metformin 500mg po stat 
7.vitals montoring 
8.tab glimi m2 po bd 
9. GRBS monitoring 2nd hourly
Day 4
patient is conscious ,coherent, cooperative
Temp - 98 F 
BP - 130/ 80 mmhg
PR - 84bpm 
CVS - S1S2 heard , no murmurs
RS- NVBS Present , no crepts
GRBS -257mg/dl
Rx
Tab levial 500mg po bd
Tab MVT po od 
Tab glimi m2 po bd 







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