Diabetic Ketoacidosis

HISTORY:

‍HyperglycemiaLethargyFatigue for ‍ ‍hoursdays

Blood glucose level: ‍

Recent HbA1c level: ‍ %

‍fatigue

‍increased thirst

‍increased hunger

‍increased urination

‍blurred vision

‍headache

‍dry mouth

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍shortness of breath

‍chest pain

‍fruity breath odor

‍lethargy

‍confusion



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Skin: ‍no rash

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍

Neurologic: cranial nerves ‍normal, strength ‍5/5 throughout, sensation ‍normal, reflexes ‍2+ throughout, cerebellar function ‍normal, gait ‍stable

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought process ‍organized, ‍no suicidal ideation, judgment ‍good



ASSESSMENT:

‍Diabetic ketoacidosis ‍likelysuspectedpossible, ‍well-controlled

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍glucose, ‍HbA1c, ‍blood gas

- Urinalysis

- ECG

- Chest X-ray

- Follow protocol

- Normal saline 1L bolus, then 500cc/h x2h, then 250cc/h x4h

- KC 20 meq/L at 150cc/h if K less than 5.5 (must have urine output)

- ‍Insulin RGlargine 0.1 units/kg/h (stop when pH normalized)

- Bicarbonate infusion if pH < 7.0-7.1

- Urine output monitoring

- Referral to ER

- Monitor glucose level every 1 hour

- Monitor electrolytes and blood gas every 2 hours

- Monitor vital signs every 15 minutes

- Admission to intensive care unit

- Referral to endocrinologist

- Follow-up in ‍ ‍daysweeks