13yrs old female with vomitings

ICU BED -3

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13YRS OLD FEMALE WITH SOB

A 13 years old female came to casualty with history of three episodes of vomiting and in a drowsy and arousable  state obeying commands

History of presenting illness :

patient was apparently a symptomatic three months back patient had developed fever and for which she was admitted in hospital and was diagnosed with diabetes patient was on human Mixtard 18 units and 16 units one day back patient did not take any insulin in the in the morning and had food and lift to school by yesterday evening patient reached home from school with chief complaints of abdominal pain and three episodes of vomiting patient was taken to outside hospital in alters and sodium state and was administered IV fluids and 10 units of HAI and 20 ML of Bicarbonate 

 past history:

Known case of diabetes mellitus type one since three months and insulin Mixtard 18units and 16 units

Not a known case of hypertension ,CAD ,CVA epilepsy ,TB ,asthma

Personal history:

Appetite normal 

Mixed diet

Bowels regular

 Micturation normal

No allergies

No addictions

Family history :

No significant family history

General examination :

patient is conscious coherent cooperative and well oriented to time place person

Vitals: 

Pulse Rate:120bpm

Blood Pressure: 100/50mmHg

Temperature:98.7degree F

Spo2:99%

No Pallor , icterus ,cyanosis ,clubbing ,lympadenopathy

SYSTEMIC EXAMINATION

=>CVS-S1S2-+

            No thrills

            No murmurs

            Right Parasternal heave-present

            No raised JVP

=>R/S-BAE-+

           NVBS-heard

           Dyspnoea-present

           Position of trachea-central

           No wheeze

           No adventitious sounds heard

=>P/A-Soft and nontender

            Shape-scaphoid

            No palpable mass

            No free fluid

            No organomegaly

            Bowel sounds-heard

=>CNS-

                 Patient was drowsy E3V4M6

                         Upper limb                               lower limb

                       Rt                    left               Rt            left

Tone     normal       normal      increased increased

Power           5/5                   5/5             5/5              5/5

Reflexes         right                left

Biceps              ++                   ++

Triceps            ++                   ++

Supinator       ++                   ++

Knee                ++                   ++

Ankle   

Plantar         flexion        Flexion