A 21-year old female (A.M) presents to the urgent care clinic with symptoms of nausea, vomiting, diarrhea, and a fever for 3 days. She states that she has Type I diabetes and has not been managing her blood sugars since shes been ill and unable to keep any food down. Shes only tolerated sips of water and juices. Since shes also been unable to eat, she hasnt taken any insulin as directed. While helping A.M. from the lobby to the examining room you note that shes unsteady, note that her skin in warm and flushed and that shes drowsy. You also note that shes breathing rapidly and smell a slight sweet/fruity odor. A.M. has a challenge answering questions but keeps asking for water to drink.
You get more information from A.M. and learn
She had some readings on her glucometer which were reading high
She vomits almost every time she takes in fluid
She hasnt voided for a day but voided a great deal the day before
Shes been sleeping long hours and finally woke up this morning and decided to seek care
Current labs and vital signs:
What is the pathophysiology for the condition you believe A.M. has?
Relate the etiology and clinical manifestations for the condition you identified for A.M.
The practitioner at the urgent care facility makes the decision that A.M. needs to go to the hospital by ambulance. Once at the Emergency Department (ED), the ED physician orders these items:
1000 ml Lactated Ringers (LR) IV stat
36 units NPH (Humulin N) and 20 units regular (Humulin R) insulin SQ now
CBC with differential; CMP: blood cultures X2 sites; clean-catch urine for UA and C&S; stool for ova and parasites; Clostridium difficile toxin, and C&S; serum lactate; ketone; osmolality; ABGs on room air
1800 calorie, carbohydrate controlled diet
Bed rest
Acetaminophen (Tylenol) 650 mg orally Q4 hrs PRN
Furosemide (Lasix) 60 mg IV push now
Urinary output every hour
VS every shift
The orders above — which are questionable related to her condition and which are appropriate?
What are the expected treatments for this condition?
