acute pancreatitis

 Old female came to OPD with Pain Abdomen

March 23, 2022

CBBLE UDHC SIMILAR CASES.


"This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current based inputs.



20 year old female student by occupation came with the chief complaints of abdominal pain since yesterday morning 7:00 am. 22/3/2022.


History of 3 episodes of vomiting present( bilious in content non projectile).


Chief complaints of pain abdomen in epigastric region insidious in onset gradually progressive in nature associated with vomitings.


Patient was apparently asymtomatic 3 years back, met with an RTA and was admitted in hospital and diagnosed with Diabetes type 1 and was on Insulin mixtard subcutaneous ( 12u----x-----12u ).


Patient was alright till 8 months back then she had epigastric pain radiating to back insidious in onset and was diagonald with acute pancreatitis and was on conservative management till then.


Non alcoholic , Non smoker.



GENERAL EXAMINATION


NO Pallor , Icterus , Cyanosis , Clubbing ,lymphadenopathy.


Vitals 

Temp - afebrile

BP - 120/100 mm hg 

PR - 120 bpm. 

RR - 19 cpm 

spo2 100 @RA 

GRBS - 259 mg/dl @ 3 Pm

CVS - S1, S2 heard 

RS : bae present 

P/A : soft , tender , Guarding Present

CNS : NA



INVESTIGATION


Serum Lipase - 135

Serum Amylase - 261


RBS - 292 mg/dl


Sickling Test on 27/03/22 - Negative


Rapid Dengue 27/02/22 - Negative


Serum Lipid Profile on 24/03/2022


Total Cholesterol - 261

Triglycerides - #932

HDL Cholesterol - #81

LDL Cholesterol - # 150


HAEMOGRAM 23/03/2022

Haemoglobin - 13 gm/dl

Total Count - 13,200

RBC - 5.46

Platelet Count - 3.36 lakh


HAEMOGRAM 27/03/2022 

Haemoglobin - 11.7 gm/dl

Total Count - 8,300

RBC - 4.87

Platelet Count - 3.68 lakh


RFT

S Urea - 29

S Creatinine - 0.7

Uric acid - 8.8

S Calcium - 10.2

Na - 137

K - 4.5

Cl - 98


LFT

Total Bilirubin - 1.52

Direct Bilirubin - 0.62

Ast - 17

Alt - 9

Alk P - 181

Total Protein - 6.8

Albumin - 3.37

A/G - 0.98

 DIAGNOSIS 


Acute Pancreatitis with DKA with Type 1 Diabetes Mellitus ( since 3 year)



TREATMENT


1. Nbm till further orders.

2. IVF- NS & RL @ 150ml/hr.

3. Inj HAI ( 39ml Normal Saline + 40 IU HAI ) @ 4 ml / hr according to Algorithm

4. Inj. Pantop 40mg/IV/OD.

5. Inj. Zofer 4mg/IV/OD.

6. Inj. Tramadol 1amp in 100 ml/NS/IV/BD.

7. Inj. THIAMINE 2amp in 1 NS/IV/TID.

8. Monitor vitals.

9. Measure abdominal girth.



SOAP NOTES


ICU Day 2 Bed 4


http://medicineelogcasesturpusharathchandra.blogspot.com/2022/03/20yr-old-female-came-to-opd-with-pain.html


S : 

No Fresh Complaints 

 


O - Patient is conscious,coherent,cooperative


vitals :


Temp - afebrile

BP - 110/80 mm hg 

PR - 99 bpm. 

RR - 18 cpm 

spo2 - 100 @RA 

GRBS - 222 mg/dl @ 8 am

CVS - S1, S2 heard 

RS - bae present 

P/A - Soft , Non tender

bowel Sounds - Present

Stools - Not Passed

CNS - NAD


I/O - 2000/1800 ml




A - Acute Pancreatitis with DKA Type 1 Diabetes 


P -

NBM 

IVF- NS & RL @ 100 ml/hr.

Inj Pantop 40mg/IV/OD.

Inj. Zofer 4mg/IV/SOS.

Inj. Tramadol 1amp in 100 ml/NS/IV/ SOS

Inj. THIAMINE 2amp in 1 NS/IV/TID.

Monitor vitals.



AMC Day 3 Bed 1


http://medicineelogcasesturpusharathchandra.blogspot.com/2022/03/20yr-old-female-came-to-opd-with-pain.html


S : 

No Fresh Complaints 

 


O - Patient is conscious,coherent,cooperative


vitals :


Temp - afebrile

BP - 110/80 mm hg 

PR - 75 bpm. 

RR - 18 cpm 

spo2 - 100 @RA 

GRBS - 215 mg/dl @ 8 am

CVS - S1, S2 heard 

RS - bae present 

P/A - Soft , Non tender

bowel Sounds - Present

Stools - Not Passed

CNS - NAD


I/O - 1500/1300 ml




A - Acute Pancreatitis with DKA with Type 1 Diabetes 


P -

Oral Sips Of water Given

IVF- NS & RL @ 100 ml/hr.

Inj Pantop 40mg/IV/OD.

Inj. Zofer 4mg/IV/SOS.

Inj. Tramadol 1amp in 100 ml/NS/IV / SOS

Inj. Optineuron 1amp in 100ml NS/IV/OD

Monitor vitals.



Ward Day 4


S : 

No Fresh Complaints 

 


O - Patient is conscious,coherent,cooperative


vitals :


Temp - afebrile

BP - 110/80 mm hg 

PR - 72 bpm. 

RR - 18 cpm 

spo2 - 100 @RA 

GRBS - 243 mg/dl @ 7 am

CVS - S1, S2 heard 

RS - bae present 

P/A - Soft , Non tender

bowel Sounds - Present

Stools - Passed

CNS - NAD


I/O - 1500/1300 ml




A - Acute Pancreatitis secondary to Hypertriglyceridemia with DKA , with type 1 DM 


P -

Oral feeds allowed

IVF- NS & RL @ 100 ml/hr.

Inj Pantop 40mg/IV/OD.

Inj. Zofer 4mg/IV/SOS.

Inj HAI acc to GRBS TID / SC

Inj. Tramadol 1amp in 100 ml/NS/IV / SOS

Inj. Optineuron 1amp in 100ml NS/IV/OD

Monitor vitals.


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