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.
一名26歲的第1型糖尿病成年個案，在出現噁心、嘔吐、多尿和進行性虛弱18小時後就診。胰島素幫浦輸注管仍然彎曲，個案表示自前一晚以來幾乎沒有接受胰島素。個案四天前喝了兩杯啤酒，自昨天以來沒有進食。個案意識清楚；腹部柔軟，無腹肌僵硬或反彈痛，個案表示瀰漫性腹部不適始於嘔吐。上個月的A1C為9.8%。生命徵象：心率124次/分，深呼吸30次/分，血壓96/60 (平常124/78)，體溫37.2 C，室內空氣下血氧飽和度98%。實驗室結果：血糖462 mg/dL，β-羥丁酸5.8 mmol/L，靜脈pH 7.19，碳酸氫鹽10 mmol/L，鉀5.4 mmol/L，血清鈉130 mmol/L，肌酸酐1.5 mg/dL，白血球16,800/mm3，無帶狀嗜中性球，有效滲透壓286 mOsm/kg。尿液分析顯示葡萄糖和酮體，亞硝酸鹽和白血球酯酶呈陰性。