Question

Sandra Stein, 36, has Type 1 diabetes. She's had the flu for the last 4 days and hasn't eaten or taken her insulin. Her husband brings her to the ED; she's confused and lethargic. During your admission assessment, you note that she's breathing rapidly and that her breath has a fruity odor. Her ABG values on 40% oxygen by face mask and her glucose levels are as follows:

pH, 7.15

PaCO2, 30 mm Hg

PaO2, 130 mm Hg

HCO3-, 10 mEq/liter

SaO2, 94%

Serum glucose, 690 mg/dl.

1. Determine the acid-base disorder using the methods outlined above.

2. Determine the cause (s) of the acid-base disorder.

3. Suggest treatments

Answer 1

1.pH - 7.15 (low) as cpmared to the normal value which is 7.35 -7.45. Since it is less than normal it is acidosis

2.PaCO2 - 30 (low) as compared to the normal range which is 33-45mm hg. This is also less than the normal. Since, pH and PaCO2 change in the same direction it is metabolic acidosis.

3.HCO3 range is 10meq/Land the normal range is 22-28meq/l -So it is metabolic acidosis.

4.PO2 is 130 and the normal range is 80-100. So, this patient has hyperoxemia.

So, from all these we can say that patient have metabolic acidosis with hyperoxemia.

Part 2

CAUSES

The common causes of metabolic acidosis are;

1.Alcoholic ketoacidosis.

2. Diabetic ketoacidosis

3. Kidney failure.

4. Lactic acidosis.

5.toxins.

6.Gastrointestinal bicarbonate loss resulting from prolonged diarrhea.

7.renal bicarbonate loss.

In this patient diabtic acidosis develop due to increase of ketone bodies in the body which is mostly known as diabetic ketoacidosis which the patient has all symptoms including,fruity smeeling breath,confusion, high sugar levels which is 690mg/dl.

THIRD PART; TREATMENT.

First of all the patient must be closely monitored. So, to assess the condition, first check the vitals signs hourly for first few hours and then Q2h and then Q4H. This can be checked ,manually or with the help of the cardiac monitor.

Secondly fluid replacement therapy. Since, the patient had lost all electrolytes and fluid from the body through sweating, IV fluid should be administered.

Finally, Insulin shoud be given as per the doctors order.

In addition to all these treatments, the patent must be given educaion about the dietary supplements also.