Case Study : Diabetic Ketoacidosis

The Consultation Report dated 12/07/2016, indicated that the claimant presented with uncontrolled type 2 diabetes mellitus. He also had a chronic back pain, arthritis, and a history of diabetic neuropathy. His blood sugar was 800 (critical stage). His blood pressure was 129/62 mmHg. The physical examination revealed mild thyromegaly, a decreased air entry at the base of the lungs, and a decreased peripheral palpable pulse. The exam also revealed loss of hair and chronic ischemic changes. Toe deformity and peripheral deformity were noted. He was on Levemir and Novolog. According to the provider, the claimant was on steroids, which has caused an increased blood sugar level. HBA1c

“Diabetes is a silent killer” (Demille 2005, p.5). It is a metabolic disorder that can result in impaired quality of life and serious complications. This study aims to understand the case of Mr. Skyler Hanson who is newly diagnosed with Diabetes Mellitus Type 1 that leads to diabetic ketoacidosis which was confirmed by the presence of moderate to high ketones in the urine and a high blood glucose level. It was noted that he has a history of fatigue, headache, abdominal pain, nausea and frequent urination. Furthermore, it was disclosed that he has difficulty in adjusting to his diagnosis and he occasionally missed administration of insulin dose when socialising. Subsequently, he was admitted in the Critical Care Unit for rehydration,

DKA is presented with three major physiological disturbances which are hyperosmolality due to hyperglycemia, metabolic acidosis because of the buildup of ketoacids, and hypovalemia from osmotic diuresis. Diabetic ketoacidosis is caused by a profound deficiency of insulin, its most likely occur in people with type 1 diabetes, inadequate insulin dosage, poor self management, undiagnosed type 1 diabetes, illnesses and infections. In type 1

History of present illness: 50 year old African American female presents to the clinic today to follow up on her Diabetes. Patient diagnosed with Diabetes in 2000. Last Diabetes checkup three months ago. Patient reports that she takes all of her medications as prescribed. Patient is currently on metformin and Lipitor. Patient denies any episodes of hypoglycemia. Patient denies experiencing symptoms of polyuria, polydipsia, and polyphagia. Patient reports that she has been checking her

At Yale New Haven on the medicine floor SLA 4, the nurse manager identified the need of education on both the hyperglycemia and diabetic ketoacidosis protocols. The nurses and doctors were not aware of the steps outlined in the protocol that needed to be followed. There have been several incidents across the hospital of orders not being correctly prescribed by physicians and nurses following through with these incorrect orders, therefore seriously effecting patient outcomes. Specifically on SLA 4 there was a recent incidence of a patient coming off of an

J. J. is a 12-year-old, independent, type 1 diabetic; diagnosed at 5-years-old. Her experience of being diagnosed was a difficult and almost fatal one. It all started when J. J. got a bad ear infection and had an accident, which was extremely abnormal for her. The doctor put her on amoxicillin, and a week later she came down with a rash. J. J.’s mother brought her the doctor, and he thought it was mono. They did a mono test and the results came back negative, however, the doctor was sure it was mono. He told J. J.’s mother to stop giving her the amoxicillin and that the symptoms would subside. They stopped taking the antibiotic, however, J. J. symptoms got worse. She was frequently thirsty, using the restroom often, sleeping a lot, and would complain of stomach pain. J. J.’s mother said, “my ex and I would ask if the doctors were going to test her blood. None of the doctors did” (personal communication, October 26th, 2016). J. J. went to 4 different doctors before she was in some much pain that she couldn’t move and was throwing up; later that day, she was diagnosed in the Ellensburg’s Emergency Room. J. J.’s mother stated, “the ER doctor walk into the room and immediately said she diabetes, and needs to go to children’s now. The doctor said she could smell the ketones on J. J.’s breath.” (personal communication, October 26th 2016). Ketones are substances that the body creates, when it breaks down fat, instead of carbohydrates for energy. Ketones make the blood

The patient is a 72-year-old black female who presented to the ED with complaints of low blood sugar. Her son found the patient at home in bed unresponsive. The son states he checked the patient's blood sugar it was 47. The patient is on NovoLog 3 times a day and Lantus one time a day. The patient had similar symptoms in the past. The patient has a medical history of dementia. She also is known to be hypertensive, insulin-dependent diabetes and has no surgical history. It is to be noted on presentation her BP was 128/95 with a pulse of 52, respirations of 15, hypothermic with a temp of 93 and oxygenating 94% on room air. She also showed significant bradycardia. EKG at 48 beats per minute, T waves were inverted in leads 4, 5 and 6 but

Diabetes is a serious medical condition that affects millions of people every year. Although both type 1 and type 2 diabetes have similarities, distinctions can be found in the symptoms, preventative methods and hyperglycaemic levels. Symptoms regarding type 1 diabetes tend to surface between infancy and adolescence, whereas symptoms for type 2 diabetes may only be revealed through diagnosis. In the past this disease has primarily been discovered in adulthood, but an increasing trend in the number of children being diagnosed has altered this perspective.Preventative procedures also differentiate both type 1 and type 2 diabetes. Extensive research conducted on type 1 has revealed to healthcare providers that prevention is not possible by any

The patient’s physical examination upon admittance (11/30/14) revealed the patient awake, alert and orientated x3; she was in some apparent distress but was not found to be in any pain. Auscultation of the lungs conceded adequate air entry bilaterally with bilateral rhonchi. The lower extremities showed pedal edema but with no signs of a deep vein thrombosis in the legs. Examination of the head, eyes, ears, nose and throat (HEENT) showed pink and moist oral mucosa. The pupils were equal and reactive to light.

Diabetic ketoacidosis is an event which occurs when there is not enough insulin in the body to utilize sufficient amount of glucose needed to provide cells with energy; body then starts to use fatty acids as a fuel, which are converted to ketones in the liver. In healthy people who do not have diabetes, ketone bodies are produced in normal quantities and then successfully used by tissues as energy supply. This state is known as dietary ketosis and it is completely normal and may even provide health benefits. But in those who have diabetes, ketones are produced in enormous quantities and aren't used in full by cells, so they start to build up in the blood. Acids 3-hydroxybutyric acid and acetoacetic acid are produced rapidly causing decrease in buffering capacity of the blood and eventually depleting buffering systems (Manninen, 2004).

Classic symptoms of diabetes usually presented with newly diagnosed diabetics are: hyperglycaemia, polyuria, polydipsia, polyphagia, fatigue, blurred vision, headaches, and unexplained weight loss. Ketone bodies are found in the urine, this abnormal finding occurs when fatty acid by-products (acetones) are excreted in the urine. The ketones are present from a lack of the insulin hormone used to metabolize fats and carbohydrates. Diabetic ketoacidosis (DKA) is a life-threatening complication which results from minimal useful insulin hormone in the body, hypoglycaemia, or insufficient food intake (American Diabetes Association, 2008).

A 48-year-old woman arrives to hospital displaying signs of headache, tiredness, thirst, dizziness, lack of concentration and numbness in the hands and feet. The lab results show that her blood sugar readings 425 mg/dL are higher than natural. She admits to a few dietary indiscretions, such as having multiple servings of dessert when going out with family. She lives in Fort Lauderdale. She is being medically reviewed at Broward Health Medical Center.

If anyone has more sugar level in the body than required, insulin assists to store the sugar in the liver and releases when the sugar level in blood is low or it sustains correct proportion during physical activity and in between meals. The main advantage of

Diabetes mellitus, commonly known as diabetes, is a metabolic disorder characterized by chronic high blood sugar levels. It is caused by an absolute or functional deficiency of circulating insulin, resulting in an inability to transfer glucose from the bloodstream into tissues where it is needed as fuel (Ahmed, Laing and Yates 2011). The disruption in the metabolism of carbohydrates, fats and proteins interferes with the secretion or action of insulin, which plays a vital role in the metabolism and utilization of energy from the nutrients especially carbohydrates. Insulin is produced in the pancreas and secreted in the gastrointestinal tract in the response to high blood sugar levels after ingestion of a substance (REFERENCE).

Diabetic ketoacidosis (DKA) DKA and hyperosmolar hyperglycemic syndrome (HHS) occurs in 20 % of the elderly who have not previously been diagnosed with diabetes. HHS is more often found in the elderly, being precipitated by an acute illness or drug therapy (Childs, Cypress, & Spollett, 2009). DKA and HHS, are both similar in the aspect for a decrease in the effective concentration of insulin in conjunction with the counter regulatory hormones glucagon, cortisol, growth hormone and epinephrine. However, DKA and HHS differed in the driving force, degree of insulin deficiency, serum glucose levels, pH, serum osmolality and duration of symptoms (Childs, Cypress, & Spollett, 2009).