A case of diabetic ketoacidosis and nausea, vomiting with bilateral upper and lower limb edema and facial puffiness in a 55 year old female patient.

Case 11 A case of diabetic ketoacidosis and nausea, vomiting with bilateral upper and lower limb edema and facial puffiness in a 55 year old female patient.

June 05, 2023
A case of diabetic ketoacidosis and nausea, vomiting with bilateral upper and lower limb edema and facial puffiness in a 55 year old female patient.


Hi, I am U.Sravani, 5th semester medical student. This is an online elog book to discuss our patients health data after taking their consent. This also reflects my patient centered online learning portfolio.

Case Scenario
A 55 year old woman from Nalgonda came to OPD on 3rd of June with chief complaints of:
- bilateral upper and lower limb edema since 10 days
- nausea since 1 week.

History of Presenting Illness
- patient was apparently asymptomatic 10 days ago when she developed edema in bilateral upper and lower limbs and facial puffiness for which she consulted a local physician and was prescribed medication following which the symptoms subsidised but relapsed again 1 week ago.
- since 1 week ago she has been experiencing nausea and dysphagia associated with 1 episode of vomiting after consumption of food which was non-projectile, non-bilious, having food contents.
- h/o SOB Grade 4 since 6 months
- h/o rashes on skin 1 month ago which subsidised spontaneously
- h/o burning micturition 
- no h/o fever, diarrhea, constipation, melena, bleeding, hematemesis.

Past History
- k/c/o HTN since 5 years on regular medication
- diabetic on examination 
- n/k/c/o tuberculosis, CAD, epilepsy, asthma, thyroid disorder
- h/o abdominal surgery for mass 30 years ago
- no h/o blood transfusions

Personal History
- married
- used to work as a housemaid before 
- mixed diet
- reduced appetite
- inadequate sleep
- regular bowels
- burning micturition
- no known allergies
- alcohol and tobacco addiction 35 years ago
- analgesic abuse since 1 year

Family History
- patients mother had breast cancer
- patients brother had MI
- no diabetes mellitus
- no hypertension 
- no stroke
- no tuberculosis 
- no asthma
- no other hereditary diseases

Drug History

General Examination
- patient was conscious, coherent and cooperative
- well oriented to time and space
- well built and adequately nourished
- no pallor
- no icterus
- no cyanosis 
- no clubbing of fingers
- no lymphadenopathy 
- no pedal edema 
- bilateral upper limb edema and facial puffiness present 
- no malnutrition 
- no dehydration 





Vitals
03/06/23
- BP: 130/90 mm Hg
- Pulse rate: 108 bpm
- Respiratory rate: 24 cpm
- Temperature: afebrile 
- SPO2: 98% at RA
- GRBS: 783 mg/dL

04/06/23
- BP: 120/70 mm Hg
- Pulse rate: 88 bpm
- Respiratory rate: 22 cpm
- Temperature: afebrile 
- SPO2: 98% at RA
- GRBS: 264 mg/dL

05/06/23
- BP: 110/70 mm Hg
- Pulse rate: 110 bpm
- Respiratory rate: 24 cpm
- Temperature: afebrile 
- SPO2: 100% at RA
- GRBS: 181 mg/dL

06/06/23
- BP: 110/80 mm Hg
- Pulse rate: 114 bpm
- Respiratory rate: 22 cpm
- Temperature: afebrile 
- SPO2: 96% at RA
- GRBS: 143 mg/dL

Fluid Intake and Urine Output
04/06/23
Total Input: 5000 ml
Total Output: 405 ml

05/06/23
Total Input: 2500 ml
Total Output: 1300 ml

06/06/23
Total Input: 1600 ml
Total Output: 700 ml

Fever Chart

Systemic Examination
Cardiovascular System
- no thrills
- cardiac sounds S1 and S2 heard
- no cardiac murmurs

Respiratory System
- no dyspnea
- no wheeze
- trachea position: central
- breath sounds: vesicular
- no adventitious sounds

Abdomen
- shape: obese
- no scars, striae, engorged veins
- bowel sounds heard
- no bruits, rubs
- no shifting of dullness
- no fluid thrill
- hernia orifices: normal 
- liver: not palpable 
- spleen : palpable




Investigations






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