1. Mamta Sharma, a 35-year-old female, was admitted to Kathmandu Medical College & Teaching Hospital with pain in her abdomen and right flank, nausea, vomiting, dry mouth, and burning urination. 2. She was diagnosed with dengue fever, diabetic ketoacidosis (DKA), and a urinary tract infection (UTI). She received IV fluids, medications, and supportive care. 3. After her condition stabilized, she was discharged with advice to follow up in the medicine outpatient department in 2 days or sooner if needed, and to drink plenty of fluids.

1. Z
KATHMANDU MEDICAL COLLEGE& TEACHING HOSPITAL
Sinamangal, Kathmandu, Nepal
: 4476152, 4469064*
DISCHARGE
DEPARTMENT OF INTERNAL MEDICINE
Name of the patient: MAMTA SHARMA
Age/Sex: 35YRS/FEMALE
IP no: 164422
Address: KATHAMNDU
Bed no: 138
Date of Admission: 2079/06/21
Date of Discharge: 2079/06/27
Case Summary
Patient was in her usual state of health 2 days back when she developed pain abdomen . right flank , intermittent , non radiating,
dull aching associated with nausea. There was 1 episode vomiting , containing food particles , non projectile , non blood or
bile stained . She complains of dry mouth since 1 week .
Patient also had burning micturition for 3 days and genital pain after micturition .
No history of fever , headache.
No history of bleeding of gum and nose, black tarry stool.
No history of abnormal body movement, LOC, frothing from mouth, up-rolling of eyes.
No history of loose stool , abdominal pain , burning micturition.
Past history:
She was diagnosed with dengue fever with UTI 3 days ago under medication.
She also had high sugar levels 3 days but was not under any medication.
No history of DM, HTN, thyroid disorder .
Personal history:
Non-smoker and non-alcoholic .
EXAMINATION AT THE TIME OF ADMISSION:
On examination:
S/E:
Chest: NVBS, no added sounds
CVS: S1S2M0
P/A: Soft, tenderness + in right flank.
CNS: GROSSLY INTACT
INVESTIGATIONS 2079/06/21 2079/06/23 2079/06/24 2079/06/27
HB/PCV 13.8 10.8 10.9 9.8/28
TC 22000 7600 6200 6200
DC(N-L) 79-12 70-26 50-45 65-25
PLATELETS 252000 203000 23800 115000
RBS 337
UREA/CR 16/0.9 18/0.5 15/0.5 15/0.5
NA 134.7 140-138-139 144 140/4.5
K 4.6 2.6-3.5-3.0 3.1
T. CHOLESTEROL 85
HDL 29
TG 80
LDL 40
G/C – ill looking
PILCCOD- dehydration +
VITALS:
Temp: 98 F
Pulse: 86 pm
RR- 20/min
BP- 110/70mm of Hg
SPO2-98% in RA
DIAGNOSIS: DENGUE FEVER WITH WARNING SIGNS
DKA
UTI
DEPARTMENT OF INTERNAL MEDICINE
PROF DR. MATHURA KC
ASST. PROF. DR. SUBASH PANT
DR. ALOK DHUNGEL
DR. ANANTA ARYAL
DR. SUNIL ACHARYA
DR. ABISHKAR ACHARYA

2. Z
HBA1C 14.1
URINE PREGNENCY
TEST
NEGATIVE
URINE RME PUS CELLS: 1-2
EPI CELLS : 2-3
RBC : NIL
URINE ACETONE +++ -
Treatment in the Hospital:
Patient presented to ER and was admitted to MEDICINE ICU and then after 3 days shifted to MHCU and then to general medicine
WARD and where she was evaluated and managed with, IV FLUIDS, INJ MGSO4, INJ XONE , INJ HUMALOG, SYP POTKLOR,
INJ KCL and other supportive management. She is being discharged after her vitals are stable.
CONDITION AT DISCHARGE:
VITALS:
Pulse: 80bpm
RR: 20min
Temp: 98.7F
BP: 110/70mm of Hg
SpO2: 96% in RA
TREATMENT AT DISCHARGE
1. TAB
2. TAB
ADVICE:
DRINK PLENTY OF FLUIDS .
FOLLOW UP IN MEDICINE OPD IN 2 DAYS/SOS WITH CBC, PCV REPORTS
____________________
SIGNATURE OF RESIDENT
DR. LAXMAN KHATI
NMC NO : 26732
G/C: Fair
PILCCOD –Nil
S/E:
P/A: Soft, non-tender, bowel sound present.
RS: NVBS, B/L equal air entry
CVS: S1S2M0
CNS: Grossly intact