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:
- What interventions do expect to be ordered for Mr. Sweet? Why?
- What type of acid-base disturbance does he have?
- What do you think is Mr. Sweet’s Medical Diagnosis?
Expert Solution Preview
Introduction:
Based on the provided case, we are presented with Mr. Sweet, a 38-year-old individual who presents to the Emergency Department unresponsive. He has a medical history of Type 1 diabetes and has been experiencing illness for the past 3 days. Upon admission, his vital signs and laboratory results indicate various abnormalities. In this response, we will address the three questions posed regarding the expected interventions, the type of acid-base disturbance present, and Mr. Sweet’s medical diagnosis.
1. Interventions expected for Mr. Sweet and their rationale:
Considering Mr. Sweet’s condition, several interventions are likely to be ordered. These may include:
– Immediate administration of intravenous fluids: Given Mr. Sweet’s unresponsive state, high blood sugar (532 mg/dL), and signs of dehydration (rapid breathing, increased heart rate), fluid replacement will aim to correct his hypovolemia and hyperglycemia.
– Insulin therapy: As Mr. Sweet has a history of Type 1 diabetes, his hyperglycemia requires immediate correction to prevent further complications. Insulin administration will help lower his blood sugar levels.
– Electrolyte replacement: With a potassium level of 7.2 mEq/L, hyperkalemia is present and requires urgent management. Administration of medications like intravenous insulin and glucose, along with judicious use of potassium-lowering agents, can help normalize his potassium levels.
– Antibiotics: Given Mr. Sweet’s prolonged sickness and elevated temperature (101.5°F), there may be an underlying infectious process. Administering broad-spectrum antibiotics can help target potential bacterial pathogens if an infection is suspected.
2. Type of acid-base disturbance:
Analyzing the arterial blood gas results, we observe a pH of 7.08 (below the normal range) along with a bicarbonate (HCO3) level of 12 mEq/L (below the normal range) and a carbon dioxide (CO2) level of 28 mmHg (within normal range). These laboratory findings indicate a state of metabolic acidosis. The low bicarbonate level and decreased pH suggest an excess of acid or a loss of bicarbonate.
3. Mr. Sweet’s medical diagnosis:
Considering Mr. Sweet’s history of Type 1 diabetes, elevated blood sugar, acid-base disturbance, and signs of illness, it is likely that he is experiencing a life-threatening condition known as diabetic ketoacidosis (DKA). DKA is caused by an absolute or relative deficiency of insulin, leading to uncontrolled hyperglycemia, ketone formation, and subsequent metabolic acidosis. The hallmark laboratory findings of low bicarbonate and low pH, along with the presence of fever and altered mental status, support this diagnosis.
In conclusion, the expected interventions for Mr. Sweet encompass fluid administration, insulin therapy, electrolyte replacement, and potential antibiotic use. The acid-base disturbance observed is metabolic acidosis, which likely correlates with Mr. Sweet’s diagnosis of diabetic ketoacidosis (DKA).
