Hyperglycemia

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍hyperglycemiauncontrolled diabetes

Blood glucose level: ‍

Recent HbA1c level: ‍ %



Associated symptoms: *Try using right-click for negatives*

‍fatigue

‍increased thirst

‍increased hunger

‍increased urination

‍blurred vision

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍dry mouth

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍shortness of breath

‍fruity breath odor

‍confusion



Contributing factors:

‍non-adherence to low-sugar diet

‍alcohol abuse

‍recent infection

no history of: ‍diabetes, ‍pancreatitis

no use of: ‍insulin, ‍oral hypoglycemics, ‍steroids, ‍new medication

‍low adherence to medication

‍recent medication changes





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍Hyperglycemia ‍likelysuspectedpossible, ‍well-controlled

DDx: type 1 diabetes mellitus, type 2 diabetes mellitus, gestational diabetes, steroid-induced hyperglycemia, stress hyperglycemia, postprandial hyperglycemia, Cushing's syndrome, pancreatic insufficiency, chronic pancreatitis, pancreatic cancer, somatostatinoma, glucagonoma, parenteral nutrition, infection, critical illness, sepsis, stroke, myocardial infarction, insulin resistance, polycystic ovary syndrome, alcohol-induced hyperglycemia





PLAN:

Investigations:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍glucose, ‍HbA1c, ‍lipid profile

- Urinalysis

- ECG

Treatments:

- Increase oral anti-diabetic dose

- Increase insulin dose

- Lifestyle modifications: low-sugar diet, exercise, weight loss

- Blood glucose monitoring

Further care:

- Referral to endocrinologist

- Follow-up in ‍ ‍daysweeks