Case presentation 1 Patient name In patient no Age Gender Date of Admission Date of Discharge No of days Kasturi More 274882012 60 Female 141212 211212 8 days Patients present complaints ID: 1033366
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1. Type 2 diabetes mellitus with essential hypertension with urinary tract infectionCase presentation - 1
2. Patient name :In patient no:Age :Gender :Date of Admission: Date of Discharge:No of days:Kasturi More27488/201260Female14-12-1221-12-128 days
3. Patients present complaints:c/o pain in abdomen.c/o feverc/o burning micturationHistory of present illnessPatient is a known case of type 2 diabetes mellitus since 18 years. Since 15 days she has developed pain in abdomen which is sudden in onset. It is associated with fever and with burning micturation. Since 15 days fequency of micturation is 8- 10 times in the night and around 16-18 times during the day.No h/o of vomitingsNo h/o of diarrhoeaNo h/o of weight loss.
4. LAB RESULTSDate14-1215-1216-1217-1218-1219-1220-12Temp39393838383737BP130/80138/72139/75150/92140/80137/73130 80Pulse85 bpm72 bpm90 bpm90 bpm92 bpm96 bpm92 bpmGRBS290270240200170138140Complete Blood countRBC2.41WBC8000Hb8.3PCV21MCV87.1MCH23.2MCHC28.9
5. DIAGNOSISBased on the subjective and objective findings:This is type 2 diabetes patient with essential hypertension with urinary tract infectionUrine ExaminationPus cells ( normal 1-5)8-10
6. Diabetes mellitusDiabetes mellitus (DM) is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. The term diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.Type 2 diabetes Was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. Type 2 diabetes may account for about 90% to 95% of all diagnosed cases of diabetes. It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce insulin. Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity.
7. Schematic representation of diabetes mellitus
8. Urinary tractinfectionsWhat is UTI?A UTI is an inflamation usually caused by bacteria (or germs) attacking the kidney, ureter, bladder, or urethra.Organisms that cause UTI:a. Escherichia coli (gram-negative enteral bacteria) causes most community acquired infectionsb. Staphylococcus saprophyticus, gram-positive organism causes 10 – 15%c. Catheter-associated UTI’s caused by gram-negative bacteria: Proteus, Klebsiella, Seratia, Pseudomonas
9. Symptoms of UTI?Feeling an urgent need to urinate, although amount is small.Burning during urination.Cloudy or foul smelling urine.Pain in lower abdomenWho can get UTI?If u have abnormal urinary tractWomen during pregnancy.People with diabetes mellitusPatients with indwelling urinary catheter.Note: women have greater tendency to get UTI than men.
10. HYPERTENSIONDefination: It is the persistant increase in systolic blood pressure with a consequent increase in diastolic blood pressure.Normal BP: 120/80 mmHgHypertensive BP:Systolic BP: >140 mmHgDiastolic BP: > 90 mmHgHypertension is of 2 main types:Primary essential (90-95%)Secondary (5-10%)
11. Pathophysiology for HTNIncreased concentratin of plasma level of catecholamines.Increase in blood volume i.e, arterial over filling and arteriolar constriction.Increase in cardiac output.Low renin essential HTN (due to alered responsiveness to renin release)High renin essential HTN ( due to decreased adrenal resposiveness to angitensin 2.
12. DRUGS181920212223Tab rablet20 mg1-0-01-0-01-0-01-0-01-0-01-0-0Tab zerodol-pAceclifenac + paraceamol 1-0-11-0-11-0-11-0-11-0-11-0-1Telmisartan 40 mg1-0-01-0-01-0-01-0-01-0-0Inj orofer 1 amp 100 mlsossosTab orofer-xt follic acid1-0-11-0-11-0-11-0-11-0-11-0-1Inj Dynapar 1ampDiclofenac sodsossossosT. Stafcure500mgcefuroxime1-0-11-0-11-0-1T. Oflox 1amp1-0-11-0-11-0-1 spironolactone 50 mg(1-0-1) twice a day1011-0-11-0-11-0-11-0-1Sodium Pico sulphate syrup
13. Indication of drugs usedRablet( rabeprazole): antacid to reduce stress ulcersZerodol( aceclofenac – paracetamol): to reduce fever caused due to infection.Telmisartan( ARB): To reduce high blood pressure.
14. 6. Orofer( follic acid- ferrous): Given as an iron supplement because of low Hb levels.7. Dynaper(diclofenac sodium): given for pain when required.8. Stafcure( cefuroxime): given for urinary tract infection.9. Oflox(ofloxocin): given for urinary tract infection.
15. Drug interactionsOflox and Terbutalin: Prolongation of QT time. Risk of ventricular arrthymias.Management: patient should seek a continuous medical assistance.Oflox and Diclofenac: potential risk of CNS toxicity. Patients with sezieurs may be at risk.Management: clinical monitoring.Fluro must not be prescribed with NSAIDS.Diclofenac and Telmisartan: attenuates the antihypertensive effect.
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