Question

What if the client with type 1 diabetes mellitus displaying symptoms of nervousness,

confusion, pallor, diaphoresis, and tachycardia suddenly becomes unconscious with shallow

breathing?

What actions would you take and what is your rationale for those actions?

Answer 1

• This patient is suffering from type 1 diabetes mellitus.
• In this condition, the patient has a deficiency of insulin.
• Therefore, these patients are usually on injection insulin

this patient is displaying following symptoms:

• Nervousness
• Confusoin
• Pallor
• Diaphoresis
• Tachycardia
• Shallow breathing
• Loss of consciousness

These symptoms are consistent with the diagnosis of diabetic ketoacidosis. This condition arises due to acute shortage of insulin in the body and increase in counter-regulatory hormones ( glucagon, catecholamine, cortisol and growth hormone)

This leads to :

1. Increase in blood glucose levels
   1. Blood glucose levels increase due to increase in glyconeogenesis and glycogenolysis ( reduction in the glycolysis)
   2. This leads to hyperglycemia.
   3. Hyperglycemia increases the plasma osmolarity.
   4. This causes osmotic diuresis.
   5. This leads to dehydration.
2. Increase in free fatty acid levels
   1. Increase free fatty acid levels occurs due to increase in lipolysis.
   2. This occurs due to insulin deficiency and increase in glucagon.
   3. The fatty acid undergoes ketogenesis and forms ketone bodies like acetone and beta-hydroxybutrate.
   4. These ketone bodies reduces alkali levels in the body. This leads to metabolic acidosis.
   5. The body tries to compensate with respiratory alkalosis ( rapid shallow breathing)

  The action that needs to be take and their rationale is as follows:

Give intravenous insulin	As there is shortage of insulin
Give i.v fluid Start with 0.9% normal saline	this is compensate for dehydration.
KCl drip	if the patient has hypokalemia
investigation into the cause of deranged sugar Chest X-ray Urine culture Blood culture	to identify the precipitating factor
Bicarbonate drip	if the pH is less than 6.9