Metabolic Acidosis: Diabetic Ketoacidosis David Mandel, who was… Metabolic Acidosis: Dia

Metabolic Acidosis: Diabetic Ketoacidosis David Mandel, who was… Metabolic Acidosis: Diabetic KetoacidosisDavid Mandel, who was diagnosed with type I diabetes mellitus when he was 12 years old (see Case 31), is now a third-year medical student. David’s diabetes remained in control throughout middle and high school, college, and the first 2 years of medical school. However, when David started his surgery clerkship, his regular schedule of meals and insulin injections was completely disrupted. One morning, after a very late night in trauma surgery, David completely forgot to take his insulin! At 5 am, before rounds, he drank orange juice and ate two doughnuts. At 7 am, he drank more juice because he was very thirsty. He mentioned to the student next to him that he felt “strange” and that his heart was racing. At 9 am, he excused himself from the operating room because he thought he was going tofaint. Later that morning, he was found unconscious in the call room. He was transferred immediately to the emergency department, where the information provided in Table 4-10 was obtained.Blood pressure 90/40Pulse rate 130/minRespirations 32/min, deep and rapidPlasma ConcentrationGlucose 560 mg/dL (normal fasting, 70-110 mg/dL)Na+ 132 mEq/L (normal, 140 mEq/L)K+ 5.8 mEq/L (normal, 4.5 mEq/L)Cl- 96 mEq/L (normal, 105 mEq/L)HCO3- 8 mEq/L (normal, 24 mEq/L)Ketones ++ (normal, none)Arterial BloodPo2 112 mm Hg (normal, 100 mm Hg)Pco2 20 mm Hg (normal, 40 mm Hg)pH 7.22 (normal, 7.4)t a b l e 4-10David’s Physical Examination and Laboratory ValuesBased on the information provided in Table 4-10, it was determined that David was in diabetic ketoacidosis. He was given an intravenous infusion of saline and insulin. Later, after his blood glucose had decreased to 175 mg/dL and his plasma K+ had decreased to 4 mEq/L, glucose and K+ were added to the infusion. David stayed in the hospital overnight. By the next morning, his blood glucose, electrolytes, and blood gas values were normal.Questions 1 What acid-base disorder did David have? What was its etiology? 2 Did David’s lungs provide the expected degree of “respiratory compensation”? 3 Why was his breathing rate so rapid and deep? What is this type of breathing called? 4 How did David’s failure to take insulin cause his acid-base disorder? 5 What was David’s serum anion gap, and what is its significance? 6 Why was David so thirsty at 7 am? Health Science Science Nursing MEDICAL SURGICAL NURSING NUR16 Share QuestionEmailCopy link Comments (0)

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