السلام عليكم
45 yo male known case of epilepsy
with poor compliance
And dm on insulin
Presented to ED with frequent time fit at night and came with post ictal state
للوهلة الأولى من الهستري سبب الفت انو الشخص ما ملتزم ب علاجه لكن
By examination, Paitent was confused with GCS 10 , dysnic RBS 400mg/dl , tachypnic , Bp80/60, pr80, spo2 95% on RA
No neurological deficit except Babinski up
كان القرار send for brain imaging لكن قبلها دزيت ecg كواحد من work up Ix ولان هو سريع و available والنتيجه hyperacute tented Twave
Put patient on cardiac monitoring and send for ABG, GUE
طلع severe HAGMA
Low Na 118 , high K 8.1 with elevate renal induces and wbc 24!
انطينه الاولوية ل hyperkalemia with fluid hydration وعالجناها بالروتين منجمنت لكن بقى المريض تجيه focal fit نتيجة ال severe hyponatremia
بعدها CT imagine was done and was negative
Then Patient admiited to ICU with DKA schedule and antibiotics
Serial ABG demonstrated good response with effective respiratory compensation and electrolytes return gradually to normal value with
S.Na 140
S. K 3.6
After 2 day paitent return concious without fit episodes and can be eating orally, dka managment was stopped and stay for observation

Good case 👆🔥

56 year old female patient complaining of chest pain and dyspnea

اجه للطوارئ انطيناه supportive therapy
Iv fluid
Paracetamol vial
Zofran amp.

وراها دخل للردهة وبلشنا work up

CBC
ESR
RFT
LFT + coagulant profile
ANA
Colonoscopy
OGD
Fecal calprotection
GUE
LDH
Virology
US

Ddx. Ig A vasculitis (HSP) mostly
Behet لان عندة طلع mouth ulcer
Drugs induced vasculitis
IBD
DIC

ال definitely Dx هو HSP
بس بعد لازم exclude behet disease بقى ضمن DDX

MRCP
DM type 2