Diabetic problem

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Diabetic problem

  1. 1. Case StudyMr Hassan is your diabetic patient , aged 45 years and suffer from diabetes Since 5 years , he ring you this morning because he feel severe epigastric.Pain associated with repeated vomiting and Sweating Ask the patient 3 questions before you advice him Remind me about your treatment Do you have any other $ diarrhea, chest pain Make random sugar and call me immediately No diarrhea Random sugar is HHH
  2. 2. ,Mr Hassan you have to be admitted to Hospital immediately once their let the physician to call meIn the ER the physician , after a short history ,and checking vital signs recommend the Nurse to take the followings Random Sugar Bp 90/60 Pulse 100 regular Temp 37.5 C ABG arterial sample Iv root and take an enough venous sample Urine ECG
  3. 3. Work blood for• Random sugar• Urine for sugar and acetone• Electrolytes• Renal function,hepatic function• CBC• Serial Troponin HS, cardiac enzymes• Urine and Bld culture• ECG• Chest radiology and US bed side
  4. 4. DD• MI• DKA• Hypoglycemia• Ketosis (starvation, Alcoholic, Pregnancy)• Acute Abdomen• Gastroenteritis• Others
  5. 5. Severity of the condition• Po2, Pco2, O2 saturation• pH• Hco3• Anion gap• Osmolality• State of consiousness• PPT factor MI, infection, stroke
  6. 6. The following patient data• Random Sugar 600mg%• Urine Sugar +++, acetone++• K 5.2mEqu/L• pH 7.3• Hco3 15• Anion gap 16• Osomolality 300• Creatinine 1.2• CBC leukocytes 12.000• Troponin +ve (2nd analysis)• ECG Non Q wave infarction
  7. 7. Diagnosis• MI• MI+DKA (stress)• HHS• Others
  8. 8. Admission in ICU,CCU• Monitor• Treatment of ppt condition• Cardiology Consultation & intervetion• Fluid ressusitation (MI, CVP)• Electrolytes• Insulin
  9. 9. Mr Hassan known to have IHD• Intervention• Fibrinolytic agent• Heparinization• Antiplatelets• Hydration CVP• O2
  10. 10. Expected complications• Cardiac complications MI• Hypoglycemia• Prolonged DKA• Brain edema• Thromboembolic• Renal failure• ARD syndrome• Arrhythmias
  11. 11. Hyperglycemic crises is it preventable• yes• How• Patient health education• Improvement diabetes care

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