SHORT CASE: A 18yr old female of Diabeticketoacidosis with perianal abscess
-pain and swelling in the perianal region since 10 days
-fever since 1 week
-shortness of breath since 2days
History of present illness:
The patient was apparently asymptomatic 6 years ago.
1 week ago:
Patient had swelling over anal that increased to the present size of 4x 4 cms along with discharge of pus and mixed with blood,
And also she had high grade fever associated with chills and rigors,she took antibiotics prescribed by a local doctor.
She had used those antibiotics for 5 days , later developed nausea
And she decreased her insulin dosage on her own since 3 days and developed shortness of breath on rest since 2 days.
As sob was increased ,she got her Grbs checked at home and it was 480mg/dl, was taken to local hospital and was given injection ( not known).
Since today morning her sob was increased went to hospital and RBS being high, insulin14u HAI given and further management is prescribed.
Past history:
History of similar complaints of swelling in inner thighs and in gluteal region 1 year back as she has taken covid vaccine.
On that time and she consulted local doctor and recieved antibiotics ( amoxiclav 625mg/bd for 5 days and also herbal medicine for swelling, local application it got relieved.
Not a k/c/o hypertension, Tb,asthma, epilepsy, thyroid disorders.
Menstrual history:
Age of menarche: 13 years
Menses: regular,28 days cycle
associated with pain and clots
Personal history:
Diet: mixed
Appetite: decreased
Bowel and bladder: regular
Sleep: adequate
Addictions: no
Family history:
Her father is a known case of diabetes since 16 years and he was using insulin mixtard 2 times daily
General examination:
Pallor: present
Icterus: absent
No cyanosis, clubbing, lymphadenopathy,edema
Vitals:
Temperature: 101 F
Bp: 120/70mmhg
PR: 92 BPM
RR: Tachyponeic at the time of admission
21cpm
Spo2: 98%
Grbs:
Surgery referral notes:
On local examination:
Swelling was in perianal region which was initially 1x1 cms and progressed to present size of 4x4 cms
Pus discharge present
Skin over swelling: reddish colour
Palpation:
Tenderness- positive
Local rise of temperature
Induration of skin over the swelling- Positive
Visible pus discharge
Systemic examination:
Respiratory system:
Inspection :
Position of trachea: midline
Position of Apex beat: left 5ics 1cm medial to mid clavicular line
Symmetry of chest : symmetrical
Movement of chest : normal
Palpation :
Position of trachea, apical pulse is confirmed
No tenderness over chest wall, no crepitations, no palpable added sounds, no palpable pleural rub
Percussion:
Resonant note heard.
Auscultation :
BLAE-PRESENT
Abdomen:
Shape: scaphoid
Umbilicus: central
Movements: normal
No visible pulsations or engorged veins,no visible peristalsis
Skin over abdomen :normal
Palpation: soft non tender
No tenderness or local rise of temperature
Percussion :
Liver: resonant note heared
No fluid thrills and shifting dullness
Auscultation:
Bowel sounds are heard
CVS:
S1 and S2 heart sounds are heared
No murmurs.
CNS:
Higher mental functions intact
Reflexes- present
Power,muscle tone- normal
Gait- normal
Investigations:
USG:
Pus culture sensitivity:
05/1/23:
Urine for ketone bodies: positive
Blood grouping and typing: O positive
Diagnosis:
Diabetic ketoacidosis with Type 1 DM since 6 years with perianal abscess
S/P : incision and drainage of abscess done under spinal anaesthesia ( 3/1/23)
Treatment:
Iv fluids Ns@100ml/hr
Inj Human Actrapid insulin Sc/TID
12u- 12u- 12u
Inj NPH sc/BD
15u- × -15u
Inj meropenam 1gm/iv/Bd d2
Inj Amikacin 500 mg/iv/Bd d2
Inj metrogyl 500 mg/iv/Tid d3
Inj pantop 40 mg/ iv/ bd
Inj neomol 1 gm/iv/bd
Inj Tramadol 2ampoules in 100ml Ns/iv/bd
Inj Zofer 4 mg/ iv/bd
Inj kcl 20 meq in 100 ml Ns/iv /stat
Tab orofer xt/ po/ od @2pm
Tab Dolo 650mg/po/Tid
6/1/23
: No fever spikes
Stools passed
