, is a 23-year old man with a 10 year history of type 1 diabetes presents to the hospital Emergency Medical Department with symptoms of nausea, vomiting, myalgia, polydipsia, and polyuria for almost 2 days. 3 days ago, he went to a party and drank an excessive amount of alcohol. He woke up the next day and complains “sick to his stomach”. He vomited 6 times since then, and is unable to keep any food or drink down. He stopped taking insulin. Currently he has headache. He denies chest pain, cough, fever, upper respiratory symptoms, and abdominal pain. ST has been hospitalized due to DKA. He was also diagnosed with depression for 3 years and allergic rhinitis for 5 years. He doesn’t have a family history of diabetes. His mother committed suicide. He smokes approximately 1/2 pack per day and drinks alcohol socially. He denies IV drug abuse. He works for his father. He stated that he does not follow a diabetic diet. Medications: Humulin 70/30 insulin, 30 U SC q AM Sertraline, 100 mg PO q PM Fluticasone nasal spray, 2 sprays each nostril PRN Loratidine, 10 mg PO daily Acetaminophen, 500 mg PO PRN for headache Allergies: Amoxicillin-causes rash Physical Examination: GEN: Well-developed, well-nourished male 23-year-old in mild distress VS: Breathing is deep and labored with a fruity odor; BP 100/84, HR 120 (supine); BP 98/60, HR 140 (Sitting); RR 34; T 37.0'C; Wt 58 kg (decreased 4 kg); Ht 178 cm HEENT: Dry tongue and mucous membranes CHEST: Clear to auscultation and percussion, no rales, wheezing, or rhonchi COR: Tachycardia, regular rhythm EXT: Poor skin turgor NEURO: Alert and oriented x 3 ABD: Voluntary guarding secondary to nervousness, mildly tender, positive bowel sounds Laboratory Examination Results on SI units (Conventional unit) Na 130 (130) PO4 1.5 (4.8) Hct 0.457 (45.7) K 6.0 (6.0) Glu 30 (541) Hgb 152 (15.2) Cl 96 (96) ABG: pH 7.2 LKcs 14 x 109 HCO3 14 (14) PCO2 26 BUN 14.2 (40) Cr 141 (1.6) Urinalysis: Trace protein, 4+ glucose, + ketones, -nitrites Chest radiography: No infiltrates ECG: WNL Blood cultures X 2: Pending Urine cultures: Pending OBJECTIVE DATA Physical Examination General appearance Vital Signs BP Pulse Rate Body Temp Resp. Rate Blood Glucose level Skin HEENT Neck/Lymph nodes Cadiovascular Chest Genital Rectal MS/Ext Neurologic Diagnostics Test Results (Actual Values) Normal values Interpretation
SCENARIO:
ST, is a 23-year old man with a 10 year history of type 1 diabetes presents to the hospital Emergency Medical Department with symptoms of nausea, vomiting, myalgia, polydipsia, and polyuria for almost 2 days. 3 days ago, he went to a party and drank an excessive amount of alcohol. He woke up the next day and complains “sick to his stomach”. He vomited 6 times since then, and is unable to keep any food or drink down. He stopped taking insulin. Currently he has headache. He denies chest pain, cough, fever, upper respiratory symptoms, and abdominal pain.
ST has been hospitalized due to DKA. He was also diagnosed with depression for 3 years and allergic rhinitis for 5 years.
He doesn’t have a family history of diabetes. His mother committed suicide. He smokes approximately 1/2 pack per day and drinks alcohol socially. He denies IV drug abuse. He works for his father. He stated that he does not follow a diabetic diet.
Medications:
Humulin 70/30 insulin, 30 U SC q AM
Sertraline, 100 mg PO q PM
Fluticasone nasal spray, 2 sprays each nostril PRN
Loratidine, 10 mg PO daily
Acetaminophen, 500 mg PO PRN for headache
Allergies: Amoxicillin-causes rash
Physical Examination:
GEN: Well-developed, well-nourished male 23-year-old in mild distress
VS: Breathing is deep and labored with a fruity odor; BP 100/84, HR 120 (supine); BP 98/60, HR 140 (Sitting); RR 34; T 37.0'C; Wt 58 kg (decreased 4 kg); Ht 178 cm
HEENT: Dry tongue and mucous membranes
CHEST: Clear to auscultation and percussion, no rales, wheezing, or rhonchi
COR: Tachycardia, regular rhythm
EXT: Poor skin turgor
NEURO: Alert and oriented x 3
ABD: Voluntary guarding secondary to nervousness, mildly tender, positive bowel sounds
Laboratory Examination Results on SI units (Conventional unit)
|
Na |
130 (130) |
PO4 |
1.5 (4.8) |
Hct |
0.457 (45.7) |
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K |
6.0 (6.0) |
Glu |
30 (541) |
Hgb |
152 (15.2) |
|
Cl |
96 (96) |
ABG: pH |
7.2 |
LKcs |
14 x 109 |
|
HCO3 |
14 (14) |
PCO2 |
26 |
BUN |
14.2 (40) |
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Cr |
141 (1.6) |
Urinalysis: Trace protein, 4+ glucose, +
Chest radiography: No infiltrates
ECG: WNL
Blood cultures X 2: Pending
Urine cultures: Pending
OBJECTIVE DATA
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