Mr. P, A 27 Year Old African American Man

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

The patient Matt is a 19-year-old Caucasian male that was admitted to the unit and being treated for lethargy, excessive thirst, recent unexpected weight loss, fever and frequent urination. Patient is uninsured, a college athlete (runs 3-5 miles a day on the cross country team), works 16 hours a week on the night shift, lives with five of males and says his diet consist of fast food, prepackaged meals and admits to having 3-4 beers, 3-4 day a week and has an allergy to penicillin (hives) and sulfa drugs. Patient was treated for a UTI once 3 months ago. The patient’s current vital signs are: temperature of 101.6F, heart rate of 99, respiratory rate of 22, blood pressure of 119/76, SaO2 99% on

Vital signs: Blood Ppressure: 120/78 mmHg, Hheart Rrate: 92 beats/min, Rrespirations: rate 15 breaths/min, O2 Soxygen saturation: 97% on room air

Vital sign: Patient weigh 169 pounds, temperature 99, pulse is 56, respiration rate 16, pulse ox 98%, blood pressure 96/60. Pain level

Diabetes ketoacidosis (DKA) primarily occurs in type 1 diabetes which is characterised by hyperglycaemia, polyuria, polydipsia, hyperventilation and dehydration (Mellitus, 2005).

Diabetic Ketoacidosis (DKA) is a serious disease with complications that may have fatal results in some cases. DKA is defined as an insulin deficiency that occurs when glucose fails to enter insulin into muscles such as: liver and adipose tissue. When there is an accumulation of ketones, it leads to metabolic acidosis which causes nausea and vomiting, as a result fluid and electrolytes are loss (Gibbs). There are many complications of diabetic ketoacidosis, some of the most prevalent are: Cerebral Edema, Hypolglycemia, and Acute Pancreatitis.

As we discuss acid and bases along with pH balance in blood a term that came to mind was Diabetic Ketoacidosis (DKA). This is a term that I have heard numerous times but didn’t not understand the meaning or cause. The term is commonly associated with diabetes but can also be associated with extreme exercise, low carbohydrate diets and eating disorders

O: Mr. P is alert but restless. His vital sign are Temputure-97.3, Pulse-88, resperatin-22, Blood Pressure 155/88, Oxygen Saturation on room air is 96%, Weight-210lbs, and Height 5fl 9in. Normal breathing, lungs clear on auscultation, hyperactive bowel sounds in all four quadrants, and heart sounds are normal on auscultation with regular S1 and S2 rhythm. His abdomen is soft, non-tender, extremities without clubbing, cyanosis or edema. A 12 lead EKG was done and result are pending for lipid panel, CK-MM, CK-BB, chest x-ray, Troponin I and Troponin T, CBC, BMP, and myoglobin levels.

Diabetic Ketoacidosis (DKA) is an acute complication of uncontrolled glucose levels characterized by reduced levels of insulin and presence of ketones. It is a medical emergency and results can be detrimental if left untreated. DKA is commonly seen in patients with type 1 diabetes mellitus (type 1 DM). However, critically ill patients with type 2 diabetes mellitus (type 2 DM) such as trauma, surgery or infection, are also at risk for DKA (Ignatavicius & Workman, 2013). Patients with type 1 DM are predisposed to DKA if their underlying conditions are not diagnosed early and in some cases, they may experience similar signs and symptoms without actually developing DKA. Comorbidities involving parts of

1. Ketoacidosis- The blood sugar levels and the accumulation of acids in the bloodstream as a result of non- administrated or under administrated diabetes.

CHIEF COMPLAINANT: Patient is a known diabetic, he has been converted over to insulin, he has been doing very well. His blood sugars are running in the low 100's, in the last month he has had one episode of blood sugar 57, otherwise, has done very well. He watches his diet, he tries to stay active. He has a known prior history of a lung resection for neoplasm, he has not been coughing up any blood. He does has some flem at times he has difficulty clearing. No chills or fever. No chest pain. No swelling in his legs, no leg sores. He sees podiatry every 3 months and he has an eye clinic scheduled for next month.

Cardiac arrhythmias noted, heart rate (HR) 106 beat per minute; heart rhythm was irregularly irregular, but no evidence of blood loss or internal bleeding, radial pulses was strong bilaterally.

As medical clinicians we are required to diagnose and treat patients for various conditions. Along with this diagnosis it is important to understand the pathophysiology of the condition and justify why this particular treatment/s was given. In this patient the signs and symptoms that were presented lead to the diagnosis and treatment of diabetic ketoacidosis (DKA).

The initial diagnosis is Diabetic ketoacidosis (DK) adding the symtoms of type 1 diabetes ( hyperglycemia). Once the patient arrives at the hospital, the initial interventions will focus on an aggressive management of glucose, electrolyte, and the volume of blood of the patient. A finger stick and Ketone test will be the initial action to undertake, because it will first confirm the existence of a diabetes condition (Baillie, 2012). If the level of ketone is high during the test, then there is a presence of ketoacidosis.

Diabetic Ketoacidosis, also known as DKA or Diabetic acidosis, is an acute, major, and potentially life-threatening complication in people with diabetes. It can also lead to diabetic coma or even death if a person passed out for a long time. It happens more commonly in people with type I diabetes, aka diabetes insipidus, but it can also occur in people with type II diabetes, aka diabetes mellitus. It is also more common in African, African-American, and Hispanic people. Diabetic ketoacidosis occurs in 4.6-8.0 per 1000 people with type I diabetes annually. It occurs when your body has too much levels of blood acids called ketones. High level of ketones can poison the human body. The condition develops when a body is unable to get the sugar the body needs because the it is not producing enough insulin. Insulin plays a vital part in the metabolism of the body, it helps glucose enter the cells. If the body does not have sufficient insulin, the body starts to break down fats and muscles as fuel instead. This can lead to a buildup of ketones in the bloodstream, causing chemical imbalance called diabetic ketoacidosis if left untreated. Diabetic ketoacidosis is sometimes the first sign of type 1 diabetes in people who have never been diagnosed before. For people who have already been diagnosed with type 1 diabetes, a serious illness, surgery, infection, or not using insulin the proper way can lead to DKA. Diabetic ketoacidosis is a medical emergency that needs to be addressed