ART No. 1: Ms. Blake is an older adult with diabetes and has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time. She has a history of Type I diabetes. On admission her laboratory values show: Sodium (Na+) 156 mEq/L H Potassium (K+) 4.0 mEq/L N Chloride (Cl–) 115 mEq/L H Arterial blood gases (ABGs) pH- 7.30; Pco2-40; Po2-70; HCO3-20 METABOLIC ACIDOSIS with respiratory compensation, High anion gap Normal values Sodium (Na+) 136-146 mEq/L Potassium (K+) 3.5-5.1 mEq/L Chloride (Cl–) 98-106 mEq/L Arterial blood gases (ABGs) pH- 7.35-7.45 Pco2- 35-45 mmHg Po2-80-100 mmHg HCO3–22-28 mEq/L
- List three (3) reasons on why she may have become bed ridden?
- Flu? Pneumonia?
- Based on these reasons what tests would you order?
- Accu check? CXR? Lactic Acid level, serum and urine ketone levels
- Describe the molecular mechanism of the development of ketoacidosis. (p. 744) *Pt’s who develop DKA do so bc bicarbonate buffering does not occur, which begins the development of metabolic acidosis
- Write three (3) differential diagnoses at this time?
- Is there any genetic component to the top of your differentials?
- What tests would you order?