Mr. Sweet, 38 years old, is brought to the Emergency Department unresponsive. He has a history of Type 1 diabetes and has been sick for the last 3 days. On admission his Blood sugar is 532, Potassium is 7.2 and ABG results include pH 7.08, Bicarb 12, and CO2 28. His VS are HR 116, BP 107/64, RR 36 Deep and rapid, and Temp 101.5. Answer the following questions:
What interventions do expect to be ordered for Mr. Sweet? Why?
What type of acid-base disturbance does he have?
What do you think is Mr. Sweet’s Medical Diagnosis?
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Interventions:
Insulin administration: Since Mr. Sweet has a history of Type 1 diabetes and has a high blood sugar level of 532, insulin administration is expected to be ordered to lower his blood sugar levels and prevent the development of diabetic ketoacidosis (DKA).
IV fluid resuscitation: His low blood pressure (BP 107/64) and elevated heart rate (HR 116) suggest that he may be dehydrated, so IV fluid resuscitation is likely to be ordered to correct fluid volume deficits.
Electrolyte replacement therapy: The low potassium level of 7.2 may be due to insulin-induced shift of potassium into cells and can lead to life-threatening cardiac dysrhythmias. Hence, electrolyte replacement therapy with potassium supplementation is expected to be ordered.
Monitoring: Vital signs monitoring, including continuous monitoring of blood glucose levels and electrolyte levels, is also expected to be ordered.
Acid-base disturbance: Mr. Sweet’s ABG results indicate a metabolic acidosis with a low pH of 7.08 and a low bicarbonate level of 12. The metabolic acidosis is likely due to elevated levels of ketones in the blood (a hallmark of DKA), which causes a shift in the balance of acid-base in the body. The elevated levels of ketones lead to an increase in the concentration of hydrogen ions in the blood, which results in a lower pH. The low bicarbonate level of 12 is a compensatory response to the metabolic acidosis, which helps to maintain the pH within a normal range. In a metabolic acidosis, the body tries to restore the acid-base balance by retaining bicarbonate or producing more bicarbonate, but in this case, it appears that the compensatory response is not enough to bring the pH back to a normal range.
