A 35YEARS OLD MAN WITH ACUTE PANCREATITIS

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CHEIF COMPLIANT: a 36 old year man  who is lecturer by profession came with a cheif complaint of pain in the lower rib since 10 days and vomiting since 5days.

HISTORY OF PRESENT ILLNESS: He has pain in the left lower rib region, uncontrolled sugars, diabetic ulceration in the left greater toe. 

he has complaint of vomitings 1week back which are non projectile,non bilious. He has blood in vomiting 4days back and never again.He is intolerant in drinking water and feels naseous as soon as he consumes water. 

HISTORY OF PAST ILLNESS:

He was diagnosed with diabetes  7years back and started on metformin initially then on Tab GLIMI MV1 and now since 2to 3 months he is on GLIMI MV2 .

He has no history tuberculosis, epilepsy, asthma.

PERSONAL HISTORY:

Diet: Mixed

Appetite: Normal

Sleep: Adequate

Bowel movements are regular

Chronic alcoholic, chews tobacco

FAMILY HISTORY:

Not significant

DRUG HISTORY:

Not allergic to any known drug

GENERAL PHYSICAL EXAMINATION:

The Patient is conscious, coherent and cooperative.Pallor,icterus,cyanosis,clubbing,lymphadenopathy are absent.

VITALS

Temperature: 98.7F

Pulse rate: 102bpm

Blood pressure: 130/100mm hg

Spo2: 98@RA

SYSTEMIC EXAMINATION

CVS :- S1 , S2 heard 

RS :-Bilateral air entry present 

P/A : Soft, non tender

CNS :- sensory system intact 

                 motor system intact 

                 reflexes normal 

INVESTIGATIONS:

Liver function test:

TOTAL BILIRUBIN-1.08mg/dl

DIRECT BILIRUBIN-0.24mg/dl

SGOT-18 IU/L

SGOT-10IU/L

ALKALINE PHOSPHATASE-242IU/L

TOTAL PROTEIN 7.3gm/dl

ALBUMIN-4.0gm/dl

A/G RATIO-1.23

BLOOD UREA:15mg/dl

ELECTROLYTES

SODIUM:138mEq/L

POTASSIUM: 4.1mEq/L

CHLORIDE;99mEq/L

POST LUNCH BLOOD SUGARS :383mg/dl

Serum amylase:74IUL

Serum creatinine:1.0mg/dl

COMPLETE BLOOD PICTURE:

HEMOGLOBIN 10.6gm/dl

TOTAL COUNT 5400cells /cumm

NEUTROPHILS 65percent

LYMPHOCYTES 28percent

PLATELET COUNT230

SMEAR normocytic normochromic

Treatment:

INJ PANTOP 40mg IV OD

Tab PREGABALIN 75mg OD

INJ TRAMADOL 1amp  in 100ml NS IV

INJ ZOFER 4 mg IV TID

Inj THIAMINE 100mg+ 100ml NS IV

TAB ULTRACET1/2 PO/QID

INJ HAI 10units__6 units TID premeal and INJ NPH 6units BD