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Transcript of Clinicopathologic Conference
History of Present Illness
Laboratory Test Results
Type 1 DM
Diabetic Ketoacidosis in DM
Manifestations & Precipitating Factors
Symptoms and physical signs of DK and usually develop over 24 hr.
DKA may be the initial symptom complex that leads to a diagnosis of type 1 DM, BUT it more frequently occurs in individuals with established DM.
Type 1 Diabetes
Level III - Group 7
A 21 year-old female is brought by her friend to the ER with nausea, vomiting, lethargy and dehydration.
Her history is not known since no immediate relative was there.
She was coughing for several days
and was febrile.
An empty insulin bottle,
syringes and a glucose meter
were found in her handbag.
Patient is lethargic.
BP: 80/50mmHg HR: 130bpm RR: 33cpm
Skin: cool clammy, poor skin turgor
HEENT: dry mucous membrane,
pink palpebral conjunctiva
C/L: no lesions noted, equal chest rise,
tachypnea, clear breath sounds
CVS: heart sounds normal, tachycardic
Abdomen: flat, normal bowel sounds, soft,
no tenderness, no organomegaly
Extremities: no gross deformities
Neurologic Exam: oriented
& responsive, generally weak
CXR : Mild inflammatory process in the left basal
ECG: Sinus tachycardia
of Type 1 Diabetes
Shortness of Breath
Metabolic acidosis (increased anion gap)
Serum bicarbonate <10 mmol/L
Arterial pH 6.8-7.3
Osmolality (300-320 mOsml/mL)
Reduced sodium, chloride, phosphorus, magnesium
Elevated BUN and serum creatinine
Serum potassium mildly elevated
Secondary to Pneumonia
- Young adult, 21 y.o
- Signs of volume depletion: dehydrated,
cold clammy skin
- Metabolic acidosis
- Arterial PH 7.2
- Arterial PCO2 23 mmHg
- Serum Bicarbonate decreased (10 mEq/L)
- Decreased PCO2 and PO2 with respiratory compensation
- Increased Anion Gap (16) normal: 10-14
- Leukocytosis (17,300 mg/ul)
- Creatinine only slightly increased (2 mg/dL)
Moderate Risk CAP (In-patient)
i. Cefuroxime (Zegen, Zinacef) 750mg – 1.5gm q 8 hr IV
ii. Ampicillin-Sulbactam (Unasyn) 750 mg – 1.5gm q 8 hr IV
iii. Co-Amoxiclav (Amoclav) 600mg – 1.2gm q 8 hr IV
Azithromycin 5oomg IV q 24 hr
Ex. Levofloxacin (Levox) 750mg tab OD PO x 5-7 days
Moxifloxacin 400mg OD PO 5-7 days
Check your ketone level.
Be prepared to act quickly.
Yearly pneumocccal and influenza vaccines
Severe or fatal brain damage
Arterial and venous thromboembolism
Make a commitment to managing your diabetes.
Monitor your blood sugar level.
Adjust your insulin dosage as needed.
Type 1 Diabetes
Age (21 years old)
Glucosuria (Glucose ++++)
Increased Capillary Blood Sugar (700 mg/dL)
Empty Insulin bottle & glucometer found