Question 7
A 58-year-old homeless man with long-standing insulin-treatedtype 2 diabetes has been diagnosed with right lower extremitycellulitis. He has taken a prescribed oral antibiotic for the pastweek but has not noticed much improvement. For the past 2 days, hehas complained of intermittent fevers and chills, nausea with poororal intake, and proximally spreading erythema over his right leg.On the evening of admission, a friend notices that he is markedlyconfused and calls 911. In the emergency room, he is oriented onlyto his name. The patient is tachypneic, breathing deeply at a rateof 24/min. He is febrile at 38.8°C. He is normotensive, but hisheart rate is elevated at 112 bpm. On examination, this patient isa delirious, unkempt man with a fruity breath odor. His right lowerextremity is markedly erythematous and exquisitely tender topalpation. Serum chemistries reveal a
glucose level of 488 mg/dL, potassium of 3.7 mEq/dL, andsodium of 132 mEq/L. Urine dipstick is grossly positive forketones.
Questions
A. Describe the precipitants of ketoacidosis in this diabeticpatient.
B. What is the cause of his altered mental status?
C. Describe the patient’s respiratory pattern. What is thepathogenetic mechanism?
D. What are important issues to consider in replacingelectrolytes in this patient?
(Visited 4 times, 1 visits today)
