17yr old male presented with giddiness and vomitings

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17 year old male came  with c/o Giddiness since 1week, nausea and vomiting since 1 week











HOPI- patient was apparently asymptomatic 1week ago then he developed giddiness which was sudden in onset no aggravating factors . Later he developed nausea and vomiting with consumption of food as aggravating factor.


PAST HISTORY- K/C/O cushings syndrome


PERSONAL HISTORY-

occupation -student

Mixed diet

appetite -normal 

bowel and bladder - Normal

no addiction 


FAMILY HISTORY - not significant 


PHYSICAL EXAMINATION-

no pallor, icterus, cyanosis, clubbing,  dehydration 


VITALS-

temperature - afebrile 

pulse rate - 80 bpm 

RR - 12 cpm 

BP - 80/50 mm hg 

SPO2 - 98 on RA 

GRBS - 117.mg %


SYSTEMIC EXAMINATION-

CVS-S1 ,S2 heard ,no murmurs 

RS -BAE +

 P/A - soft ,non tender 

CNS -

speech - normal 

 power 

U.L - 5/5 

L.L - 3/5 at presentation in opd ,now 4/5 

TONE - normal 

REFLEXES 

KNEE - + 

BICEP - + 

TRICEP-+

ANKLE - + 

BRACHIORADIALIS - + 

PLANTAR - withdrawal


PROVISIONAL DIAGNOSIS-

Adrenal crisis (Distributive shock secondary to adrenal insufficiancy)


TREATMENT -

1)Inj norad 2amp in 46ml NS infusion @ 0.02mcg/kg/min if BPis low 

2)Inj hydrocortisone 100mg/iv/od

3)Inj pantop 40mg/iv/od

4)Inj zofer 4mg/iv/tid

5)IVF NS,RL,DNS-100ml/hr

6)BP charting

PR/Spo2/Temp charting

GRBS 8th hrly

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