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Identifying Data

Identifying Data. R.S. 11-year-old male From Las Pi ñ as. Chief Complaint. High blood sugar Dyspnea. History of Present Illness. 6 weeks PTA. Admitted at Las Pi ñas Hospital for 8 days for sx of vomiting, fever, abdominal pain. A> DM type I. Initial CBG 518.

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Identifying Data

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  1. Identifying Data • R.S. • 11-year-old male • From Las Piñas

  2. Chief Complaint • High blood sugar • Dyspnea

  3. History of Present Illness 6 weeks PTA Admitted at Las Piñas Hospital for 8 days for sx of vomiting, fever, abdominal pain. A> DM type I. Initial CBG 518 Admitted at PER for 3 days for sx of DOB, ↓sensorium. Advised CBG monitoring and daily insulin regimen: 6am HN 5u Hr 11u 6pm HN 3u H4 5u. CBG 80 to “high”. 21 days PTA CBG recorded as “high”. PER consult, recorded CBG 89, advised to continue insulin regimen w/ good compliance 6 days PTA CBG 270, given insulin. Px fed lunch by monther. Few hours after, (+) drowsiness (+) DOB Few hours PTA Consult

  4. Past Medical History • PTB, initiated HRZE therapy 1 month PTA

  5. Family History • DM – paternal side • HTN – maternal side

  6. Birth History • FT SVD to a 22 y/o G1 at Paranaque Community Hospital (-) FMC

  7. Immunization History • (+) BCG • (+) HepB x 3 • (+) DPT x 3 • (+) OPV x 3

  8. Developmental History • At par with age • Grade 4 student

  9. Social History • Mother is a 33 y/o housewife • Father is a 32 y/o vendor • Eldest of 7 children

  10. Physical Exam • Drowsy, tachypneic • 22 kg 140 cm • 100/70 > 120 > 29 > 36.7 • AS PPC (-) CLAD (-) TPC • AP DHS tachycardic regular rhythm (-) murmurs • Flat NABS soft nontender (-) masses • FEP PNB (-) cyanosis (-) edema

  11. Physical Exam • CN I – can smell • II – 2-3 mm EBRTL • III, IV, VI – full EOM • V – (+) corneal reflex • VII – (-) facial asymmetry • VIII – intact gross hearing • IX, X – can swallow • XI – can shrug shoulders • XII – tongue midline

  12. Motor 5/5 all extremities • Sensory 100% all extremities • DTRs ++ all extremities • Cerebellar (-) nystagmus • Meningeal (-) Brudzinski

  13. Course at Er • CBG 494 • Given 20 cc/kg PNSS bolus. Started on IVF PNSS (50cc/kg/day + 2FM) consumed over 48 hours. Started on insulin 0.1u/kg/hr • Given an additional 20 cc/kg PNSS and NaHCO3 2meq/kg given over 1 hr

  14. ABGs

  15. Labs • Hgb 134 Hct .399 WBC 20.70 N .770 L .171 M .055 E .001 Plt 288 • 12MN Glucose 26.6 ↑ Bun 3.2 Crea 86.3 Ca 1.99 ↓ Na 130 ↓ K 3.9 Cl 99 • 3AM Glucose 18.2 ↑ Na 135 K 2.7 ↓ Cl 109 ↑

  16. Course in the Wards • Admitted to W11B6 • IVF PNSS 1 L + 40 meq KCl @ 733 cc/hr to run for 48 hr (TFI 60 cc/kg + 2FM over 48 hr) • O2 support 10LPM via funnel • Serum electrolytes, CBG q2

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