56 year old male

A 56yr old male came to casuality with 
chief  complaints of
 pain abdomen since 5 days
polyuria since 5 days 
Dyspepsia since 2 days 
History of present illness: 
patient was apparently asymptomatic 5 days back,then he developed pain in the abdomen (Epigastric region) non radiating,not associated with nausea,vomitings(burning type of pain) decreased on using medication 
H/o alcohol binge 5 days back,then developed pain abdomen ( diffuse type, squeezinf type of pain) not associated with nausea,vomitings)  went to a local RMP and diagonsed with Diabetes mellitus (DE NOVO) and was started on (T.GLIBENCLAMIDE and METFORMIN)/PO/OD
No H/O burning micturition,fever,cough,cold,SOB,tingling sensation of B/L UL and LL,loose stools and chest pain

Past History :
H/O simliar complaints in the past diagnosed as pancreatitis 
not a K/c/o DM,HTN 
k/c/o Alcoholic since 30 yrs 
last intake (3-5 days back)
he is a smoker ( stopped 8 years back )
Personal history:
mixed diet
normal appetite
bowel regular 
micturition normal
alcoholic since 30years 
was a smoker ( stopped 8yrs back )
General examination :
patient is concious,cooherent ,cooperative well oriented to time and place 
BP-100/70mmhg
PR-89bpm
Temp-96.5
RR-16cpm
No pallor
icterus+
No cyanosis,clubbing ,oedema ,generalised lymphadenopathy 
Systemic examination:
CVS:
S1S2 heard 
no murmurs and thrills
Respiratory:
NVBS+
BAE+
Per abdomen :
abdomen is soft
non tender 
bowel sounds heard 

Diagnosis: Chronic pancreatitis with uncontrolled sugars(Denovo DM) secondary to pancreatitis 
? Alcoholic gastritis

Treatment-
Day 1
Inj pan 40 mg IV/BD
INJ THIAMINE 2 amp in 500ml NS
INJ HAI ,NPH SC ACC TO GRBS
INJ OPTINEURON 1 amp in 100ml NS IV/BD

Day 2:
Inj pan 40 mg IV/BD
INJ THIAMINE 2 amp in 500ml NS
INJ HAI ,NPH SC ACC TO GRBS
INJ OPTINEURON 1 amp in 100ml NS IV/BD



CUE:
colour: pale yellow
appearance: clear
pH: acidicCBP:
Hb: 14.1
TLC: 8,300
Platelets: 1.76
Lymphocytes: 12
Neutrophils: 78
Eoisnophils:4
albumin: nil
sugar:++++
PC:2-3
EC: 2-4
RBC:nil


ESR: 35mm/1st hr

LFT:
TB: 7.02
DB: 2.40
AST: 234
ALT: 77
ALP: 876
Total proteins: 6.1
S. Albumin: 2.0
A/G: 0.52
HbA1c:7.4

S electrolytes: 
Na: 138
K: 3.9
Cl: 96

S creatinine: 1.0 mg/dl
S urea: 32mg/dl 
uric acid: 2.0

RBS: 430mg/dl

USG: 
-Altered echotexture of pancreas
- increased echogenicity of both kidneys 
- left simple renal cortical cyst 14x17mm in lower pole of left kidney

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