Mr. Sweet, 38 years old, is brought to the Emergency Department unresponsive. He has a history of Type 1 diabetes and has been sick for the last 3 days. On admission his Blood sugar is 532, Potassium is 7.2 and ABG results include pH 7.08, Bicarb 12, and CO2 28.

Mr. Sweet, 38 years old, is brought to the Emergency Department unresponsive. He has a history of Type 1 diabetes and has been sick for the last 3 days. On admission his Blood sugar is 532, Potassium is 7.2 and ABG results include pH 7.08, Bicarb 12, and CO2 28. His VS are HR 116, BP 107/64, RR 36 Deep and rapid, and Temp 101.5. Answer the following questions:

  1. What interventions do expect to be ordered for Mr. Sweet? Why?
  2. What type of acid-base disturbance does he have?
  3. What do you think is Mr. Sweet’s Medical Diagnosis?

1.

the emergency goals for treating diabetic ketoacidosis are rapid intravascular volume repletion also reduces hyperkalemia, correction of hyperglycemia and acidosis.

volume repletion

using IV 0.9% saline intravascular volume should be restored quickly to raise blood pressure and reduce hyperkalemia and hyperglycemia.it takes over 24 hours to correct total body fluid deficit once intravascular volume restored.after reaching blood glucose level of 200 mg/dl IV fluid should be changed to 5 %dextrose in 0.45% saline.

hyperglycemia

corrected by using regular insulin

the patient may develop cerebral oedema and can be treated with hyperventilation, corticosteroids and mannitol.

2.

he has metabolic acidosis( acid-base disturbance)

pH-7.8( NL-7.35)

bicarb-12 ( NL-22-28 mEq/L)

PaCO2-28(NL-38-42 mm Hg)

the patient is in hypotension, which is 107/64 (nl=120/80)

tachycardia-116 beats/minute

respiratory rate-tachypnea-36 breath/minute which is deep and rapid(/kussmaul respiration) to compensate for acidosis

hyperkalemia also leads to acidosis(7.2 mEq/L)

3.

Diagnosis

diabetic ketoacidosis characterised by  hyperglycemia and metabolic acidosis

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