A 26-year-old adult with type 1 diabetes presents after 18 hours of nausea, vomiting, polyuria, and progressive weakness. The pump tubing is still kinked, and the client reports receiving little insulin since the previous evening. The client had two beers four days ago and has not eaten since yesterday. The client is alert; the abdomen is soft without guarding or rebound, and the client reports diffuse abdominal discomfort that began with the vomiting. The A1C was 9.8% last month. Vital signs: HR 124/min, deep respirations at 30/min, BP 96/60 (usual 124/78), temperature 37.2 C, SpO2 98% on room air. Laboratory results: glucose 462 mg/dL, beta-hydroxybutyrate 5.8 mmol/L, venous pH 7.19, bicarbonate 10 mmol/L, potassium 5.4 mmol/L, serum sodium 130 mmol/L, creatinine 1.5 mg/dL, white blood cells 16,800/mm3 with no bands, and effective osmolality 286 mOsm/kg. Urinalysis shows glucose and ketones and is negative for nitrites and leukocyte esterase.
A 26-year-old adult with type 1 diabetes presents after 18 hours of nausea, vomiting, polyuria, and progressive weakness. The pump tubing is still kinked, and the client reports receiving little insulin since the previous evening. The client had two beers four days ago and has not eaten since yesterday. The client is alert; the abdomen is soft without guarding or rebound, and the client reports diffuse abdominal discomfort that began with the vomiting. The A1C was 9.8% last month. Vital signs: HR 124/min, deep respirations at 30/min, BP 96/60 (usual 124/78), temperature 37.2 C, SpO2 98% on room air. Laboratory results: glucose 462 mg/dL, beta-hydroxybutyrate 5.8 mmol/L, venous pH 7.19, bicarbonate 10 mmol/L, potassium 5.4 mmol/L, serum sodium 130 mmol/L, creatinine 1.5 mg/dL, white blood cells 16,800/mm3 with no bands, and effective osmolality 286 mOsm/kg. Urinalysis shows glucose and ketones and is negative for nitrites and leukocyte esterase.