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Posted: January 10th, 2023
Mr. Sweet, 38 years old, is brought to the Emergency Department unresponsive
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?
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Mr. Sweet is likely experiencing a severe case of diabetic ketoacidosis (DKA), which is characterized by high blood sugar levels and a metabolic acidosis. The interventions that would typically be ordered for a patient in this condition would include:
Insulin therapy to lower blood sugar levels and help shift the body out of DKA
Fluids to rehydrate the patient and correct electrolyte imbalances
Monitoring of vital signs, blood glucose levels, and electrolytes to track the patient’s response to treatment and ensure proper management
Potassium replacement to correct the low potassium level
Close monitoring of the ABG’s in order to titrate the therapy accordingly
Infectious source should be ruled out and antibiotics might be considered if an infection is present
Mr. Sweet’s acid-base disturbance is a metabolic acidosis. Metabolic acidosis is characterized by a pH below 7.35 and a low bicarbonate level, which is what is seen in the ABG results provided (pH 7.08 and bicarbonate of 12). The most common cause of metabolic acidosis is diabetic ketoacidosis.
Mr. Sweet’s primary diagnosis based on the information provided is likely diabetic ketoacidosis (DKA). The high blood sugar level, low potassium level, metabolic acidosis, and the patient’s history of Type 1 diabetes all strongly suggest DKA as the cause of his unresponsiveness and metabolic derangements. It would also be important to consider other possible causes, like an infection or sepsis, and rule them out based on additional information, such as laboratory results and imaging.
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