Question

Mary McGee is a 21-year-old woman with a history of type 1 diabetes, diagnosed 3 years ago. She isa college senior at the local university where she also plays softball. She started using an insulin pump approximately 6 months ago. She noticed she was usually tired and short of breath at the beginning of her practice and then began feeling weak and nauseated. She was also very thirsty during practice . Her softball coach said she seemed "a little confused." He advised her to check her blood glucose and it read HI. She checked her insulin pump and noticed the pump had become disconnected. She is unsure how long she has been without insulin. She vomited two times since shortly thereafter and was transported via emergency medical services to the emergency department.

1.a. What sign, symptoms, and laboratory findings indicate the presence and severity of DKA in this patient?

1.b. What are the precipitating risk factors for DKA,and which of those risk factors are present in this patient?

1.c. What are the diagnostic criteria for DKA?

1.d. What problems need to be addressed in DKA besides hyperglycemia?

2. What are the goals of therapy for this patient?

3. What therapies are available to correct the metabolic derangements of DKA?

4. Design a pharmacotherpeutic plan to resolve this patient's DKA.

5. a. What monitoring is necessary for the therapeutic plan that you developed for the patient?

5.b. If the blood glucose does not fall by at least 10% in the first hour, what is the appropriate next ehrapeutic step? What changes in the therapeutic regimen should be considered when the blood glucose drops below 200 mg/dL?

5.c At what point is the DKA considered to be resolved, and when can IV insulin therapy be converted to subcutaneous therapy?

5.d. Outline a plan for converting the patient from IV to subcutaneous insulin after resolution fo the DKA.

6. What additional counseling or interventions should occur with this patient regarding prevention fo future of the DKA.

Answer 1

The sign & symptoms » Volume depletion can be reveal by the physical examination. Fever due to undelying sign of acidosis. Diabetic ketoa cidosis can be determined with help of serum glucose level. The serum glucose level greater than 250mg per dl, PH less than 7.3 and serum bicarbonate level less than 18 mEq pe Lindicate severity of DKA. The major precipitating factor in the OKA is insulin dose. The missed insulin dose may result as the risk factor. The diagnostic criteria for DKA includes the blood glucose level which is more than 250 mal de and increased anion gap metabolic acidosis. The other problem to the DKA related such as: - o Extreme thirst i Nausea 0 Confusion. o High sugar levels.