A 38 year old man comes into the ER with several problems. He has had the...

A 38 year old man comes into the ER with several problems. He has had the stomach flu and has been vomiting for a couple days now. He is lethargic. His pulse rate is high, his respiratory rate is 35 and his breath smells of acetone. His glucose was high and his pH was low. What is the problem with this patient? What is your possible diagnosis?

Expert Solution

–The patient is having diabetic ketoacidosis. As he was having low BP, high pulse rate, acetone smell in breath, vomiting, abdominal pain associated with high blood glucose levels.

DIAGNOSIS :

– The person is diabetic and hasn't taken his insulin then the body doesn't get enough glucose to undergo metabolic reactions. As a result liver chooses an alternate pathway for energy source and it is breakdown of fats. It may be good for a while but long term dependence show ill effects.

–Breakdown of fats results in formation of ketone bodies. Ketones are acidic and at higher concentrations they show toxic effects.

– In diabetic ketoacidosis ketones build up in the blood altering the normal chemistry of blood and interfere with the function of multiple organs.

–They make the blood acidic which causes vomiting and a abdominal pain.

– If the acidic level of the blood become extreme it leads to rapid fall in blood pressure as in our patient with breath rate of 35 and high pulse rate.

– His blood glucose levels are very high because of absence of insulin which facilitates absorption of glucose. As a result he frequently urinates and there is loss of glucose along with sodium,potassium ions leading to dehydration.

TREATMENT:

The person has to be treated immediately in the intensive care unit.

He must be infused with fluids intravenously and should be administered with insulin so that glucose is absorbed and blood glucose levels comes to normal and recovers from acidosis.

His vital signs (BP, pulse rate, breath rate) and urinary output should be monitored till they return to normal.

Sydney Mullin answered 1 year ago

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