Question

Case Study: The Patient with Diabetes Mellitus

The patient is a 48-year-old unconscious woman admitted to the ED. She has a known history of type 1 diabetes mellitus. Her daughter accompanies her and tells the staff that her mother has had the “flu” and has been unable to eat or drink very much. The daughter is uncertain whether her mother has taken her insulin in the past 24 hours. The patient’s vital signs are temperature 101.8 F (38.7o C); pulse 120, weak and irregular; respiration 22, deep, and fruity odor; and blood pressure 80/42 mm Hg. Blood specimens and arterial blood gases are drawn and an IV infusion begun.

1. Based on this patient’s history, give the probable changes in laboratory results for serum glucose, serum osmolarity, serum acetone, BUN, arterial pH, and arterial PCO2. What medical emergency do these data indicate?

2. What type of IV solutions should the nurse be prepared to administer to this patient? What drugs should the nurse be prepared to give? Explain your answers.

3. The patient is placed on continuous cardiac monitoring. What is the rationale for this intervention?

Answer 1

1) The probable changes in laboratory results for the following :-

serum glucose - hyperglycemia

serum osmolarity - increased

serum acetone - increased

BUN - increased

arterial pH - acidosis

arterial PCO2 - decreased

The medical emergency these data indicates is Diabetic ketoacidosis .

2) Normal saline induces a hyperchloremic acidosis which drops bicarbonate levels in the initial phase of DKA resuscitation, and is probably not the ideal fluid to use. LR, Plasmalyte, or Normosol are better choices.

Medications used in the management of DKA include the following:

Rapid-acting insulins (eg, insulin aspart, insulin glulisine, insulin lispro)

Short-acting insulins (eg, regular insulin)

Electrolyte supplements (eg, potassium chloride)

Alkalinizing agents (eg, sodium bicarbonate)

3) The clinical importance of electrolyte levels in the management of diabetic ketoacidosis is the prevention of cardiac arrhythmias. Thats why ECG monitoring is the minimal standard in the management of diabetic ketoacidosis.