Case Study #2:

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Case Study #2: A 20 year old woman was brought to the ED in a comatose state. Her roommate stated that the patient had been nauseated earlier in the day. Upon physical examination, it was noted that the patient was breathing deeply and rapidly, her breath had a fruity odor and her skin and mucus membranes were dry. The family was contacted and the mother stated that the woman brother had Type I diabetes. The following laboratory results were obtained: CHEMISTRY PANEL REFERENCE RANGE Na 128 mmol/L (136-146 mmol/L) K 5.7 mmol/L (3.5-5.0 mmol/L) Cl 88 mmol/L (98-109 mmol/L) HCO3 9mmol/L (22-28 mmol/L) BUN 50 mg/dl (5-20 mg/dl) Osmolality 310 mOsm/kg (285-295 mOsm/kg) pH 7.12 (7.35-7.45) pCO2 28 mmHg (35-46 mm Hg) Glucose 750 mg/dl (70-105 mg/dl) Urine Glucose 4+ Serum Acetone 3+ 1. Identify all abnormal values. Indicate if the value is increased or decreased when compared to the reference range 2. On the basis of the patients clinical history, laboratory data and clinical findings, what type of glucose intolerance would be the most probable? Explain how the history, data and findings helped you identify the type of glucose intolerance exhibited by the patient. 3. Identify at least three (3) laboratory findings that would be most valuable in establishing the diagnosis as diabetic ketoacidosis. Explain why you consider these values to be important to the diagnosis. 4. What are the three major ketone bodies? 5. Why are ketone bodies increased in diabetes mellitis? How do they contribute to the condition of ketoacidosis? 6. Explain the glycosuria (4+ urine glucose) 7. The patient is established on a daily regimen of insulin and sent home. Which of the following tests would give the best assessment of glucose control over the next 2-3 month. Explain why this test would be

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