PakMediNet Discussion Forum : Medicine : Young Patient with acidotic breathing
A young patient 13 male, presented to us at night (11 pm) in our Emergency with 4 day history of several episodes of vomiting and weakness. He didnt have any diarrhea, fever or any other complaint. He had family history of Diabetes.
On examination, he was a concious, oriented healthy looking young patient, had BP of 60 systolic only with very feeble pulse of 130/min, marked dehydration, Respiratory rate of 20 / min with normal temperature. He had tense abdomen but was non tender, had clear chest and normal heart sounds.
He was given 3 liters of IV fluids intially. This made his BP to come at 100/60 after 5-6 hours, with adequate urine output. He was also given initial shot of Inj. Amoxycillin and Inj. Metronidazole.
In morning, he developed acidotic breathing, drowsiness and hypotension again. His BP at that time was 90/60, with feeble pulse of 120/min.
Seeing that condition, possibility of Diabetic Ketoacidosis was made and immediate ABGs were done. ABGs showed pH of 7.0 with decrease PCO2.
Immediate after 10 minutes, patient developed Cardiopulmonary arrest. He was resuscitated for 1 hour but was in vain.
His investigations that came later showed Blood Sugar of 83 mg/dl, S. Ketones of 0.3 mg/dl and Na+ of 137, K+ of 5.6.
What could be the possibilty of such a tragic expiry ?
Posted by: docosama Posts: 333 :: 15-10-2001 :: | Reply to this Message
Did you consider bowel obstruction due to as simple a reason as ascariasis or more serious like Meckel's or intussusception?
Posted by: chameed Posts: 173 :: 31-03-2002 :: | Reply to this Message
Abdomen was tense but nontender and had normal bowel sounds. In bowel obstruction, exagerrated bowel sounds, along with distention and absolute constipation should be present. And patient of these disease, do not expire that quickly.
Posted by: docosama Posts: 333 :: 02-04-2002 :: | Reply to this Message
This child was severely dehydrated with no h/o fever, diarrhoea or any bleeding, so where was the fluid going if the the chest was clear. Does vomiting explain this dehydration and if so why? Are you saying that presence of bowel sounds and lack of distention excludes bowel obstruction?
Posted by: chameed Posts: 173 :: 02-04-2002 :: | Reply to this Message
dear sir ,before coming to your last para graph,i was thinking on lines of Diabetic Ketoacidosis.But i dont think it s true.you have repoted very intersting case.may some cosultant give some proper answer.lat me know what is corect answer to this.my e.mail is abidrana@hotpop.com
Posted by: abidrana Posts: 19 :: 14-08-2002 :: | Reply to this Message
he may be having gastritis leading to vomiting and dehydration
Posted by: cardinal s Posts: 6 :: 24-05-2003 :: | Reply to this Message
A young pt who presents with hypotension, tachpnea and evidence of dehydration needs to be worked up expeditiously. His appearance and tachypnea with a tense abdomen and 4 day history suggested an abdominal catastrophe. After 3 L he should have been adequately hydrated. The fact that he became hypotensive again suggest sepsis. He may have a ruptured appendix with peritonitis and sepsis/peritonitis. His overwhelming sepsis and hypoperfusion can explain his lack of fever. Hypothermia is also a sign of fulminant sepsis. The antibiotic coverage was also not adequate. Based on resistance pattern amoxil is a useless drug. He was probably compensating for severe metabolic acidosis all through the night and went in to cardiac arrest from severe lactic acidosis. details of resusitation were not given. Surgical consult was not obtained. Abdominal xray atleast could have shown localized ilius prompting additional work up. Abgs should have done earlier in the course of the illness.
We have to learn to value human life and take vital signs seriously. It is unfortunate that this child died.
Posted by: icumicuccu Posts: 16 :: 29-04-2004 :: | Reply to this Message
Sir
You are right that peritonitis as a cause of sepsis should be suspected in this patient. However, a patient with dehydration due to excessive vomiting and a family history of diabetes, DKA should be suspected; which was ruled out. He did have severe acidosis, but what was the cause, was not properly investigated. This unfortunate child had a short stay in the hospital. Abdomen initally was soft and non tender, but later on in the morning, it was tense, but bowel sounds were still present.
He was resuscitated on the standard ACLS protocols. This child was presented in an ER of a Govt hospital, where you know unfortunately all facilities are not avaiable as well, and the cause of such antibiotic cover.
Posted by: docosama Posts: 333 :: 29-04-2004 :: | Reply to this Message
due to ph of 7 acidosis leading to anaerobic metabolism aggrevated by low b.p.and sympathetic activity increase .
Posted by: peece Posts: 2 :: 02-12-2007 :: | Reply to this Message
quote:
He had family history of Diabetes.
quote:
Posted by: chameed on 19-12-2007
……………………..any clinical knowledge or experience in medicine …………………..
Posted by: HussainA (Guest) :: 02-12-2007 :: | Reply to this Message