Endocrine Case Histories - Case 28
A 21-year-old noncompliant male with a history of type I (insulin-dependent) diabetes mellitus was found in a coma. His blood glucose was high, as well as his urine glucose, urine ketones, and serum ketones. His serum bicarbonate was <12 mEq/L. His respiration was exaggerated and his breath had an acetone odor. His blood pressure was 90/60 and his pulse weak and rapid (120). -------------------------------------------------
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1. Define noncompliant.: a nursing diagnosis approved by the North American Nursing Diagnosis Association, defined as a behavior of person and/or caregiver that fails to coincide with a health-promoting or therapeutic plan agreed on by the person (and/or family or community) and the health care professional. In the presence of an agreed-on, health-promoting or therapeutic plan, the person's or caregiver's behavior is fully or partially nonadherent and may lead to clinically ineffective or only partially effective outcomes. 2. Is this person experiencing ketoacidosis or insulin shock? Explain your answer. In diabetic patients, ketoacidosis is usually accompanied by insulin deficiency, hyperglycemia, and dehydration. Particularly in type 1 diabetics the lack of insulin in the bloodstream prevents glucose absorption and can cause unchecked ketone body production (through fatty acid metabolism) potentially leading to dangerous glucose and ketone levels in the blood.Ketoacidosis can be smelled on a person's breath. This is due to acetone, a direct byproduct of the spontaneous decomposition of acetoacetic acid.
3. Why is the serum bicarbonate low?
as the person is suffering from severe dka
] 4. What is the acid-base status of this individual?
the ph is below 7
5. What is the cause of the dyspnea, hypotension, and tachycardia? A patient in DKA needs more insulin to get the glucose into the cells. Since this isn't happening they body is using fats for fuel instead. Now they have excessive...
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