Diabetes with Diabetic Ketoacidosis Case Study 2022

Case Study 1
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Type 1 Diabetes with Diabetic Ketoacidosis
Case presentation
71 year-old female A&O x 3 admitted via Emergency Department from nursing home with
chief complaint of difficulty breathing and lethargy. Pt has dialysis port to left hand, and had
dialysis earlier in the day.
Admitting Diagnoses: Diabetic ketoacidosis without coma associated with type 1 diabetes
mellitus, Sepsis (unknown cause), ESRD, Pneumonia of both lungs due to infectious
organisms
Pertinent Medical History (pMH): CVA with resulting aphasia, seizure disorder,
hyperlipidemia, T1DM, HTN, ESRD on HD, asthma, atrial fibrillation, HCV, CAD,
hypothyroidism, neuropathy, depression, glaucoma
Surgical History (SHx): none
History of present disease: Managed in ICU for DKA earlier this year. Found to have
diastolic heart failure on echo and moderate pulmonary hypertension on that admission. Echo
is suggestive of pulmonary hypertension secondary to diastolic heart failure and IVC dilation
consistent with volume overload at the time of the study. She was admitted recently and
managed for HCAP and then CHF exacerbation.
Social History: never smoker, no alcohol use
Allergies: NKDA/NKFA
Home medications: Insulin Levemir 12 units bid and insulin Novolog 6 units premeal tid,
Metoprolol, ASA, Renvela, Synthroid 99μg/d, Eliquis, Amlodipine, Pepcid, Atorvastatin,
Keppra, MVIs
Physical Examination:
Head: NC/AT
Neuro: nonverbal upon admission
Skin: Good turgor, no rashes
HEENT: PERRL, EOMI
Musculoskeletal: WNL
Abdomen: Soft, non-tender, bowel sounds active
Extremities: Extremities normal, atraumatic, no cyanosis or edema, no calf tenderness
PHYSICAL EXAM:
General: Awake, alert, non-communicative, NAD, following commands.
CVS: S1S2, no murmur appreciated

Pulmonary: clear to auscultation bilaterally. GI: obese, Soft, non-tender, non-distended. No
organomegaly, BS+
Vascular: Normal distal pulses bilaterally.
Extremities: No edema noted
I/O
Gross per 24 hour
Intake 1188.9 ml
Output 40 ml
Net 1148.9 ml
Pertinent nutrition-related laboratory data
(24 points, see questions below the case)
Lab Reference Range Day 1 Day 3 Possible causes (bold for likely
cause(s) in this patient)
Basic/ Complete Metabolic Panel
Albumin 3.5-5.0 g/dL 2.9 L This indicates patient is suffering
from malnutrition, liver disease
and inflammation because of low
albumin levels
Total Protein 6.0-8.0 g/dL 5.8 L The total protein is low compared
with reference range and this
shows patient is suffering from
kidney disorder, malabsorption
for example bowel disease and
severe malnutrition.
Calcium, Serum 8.6-10.2 mg/dL 8.3 L The result indicate patient is with
Hypocalcemia condition due to
low level of calcium present in
blood associated with parathyroid
glands. This is also due to kidney
disorders, drugs and diet intake.
HGBA1C 4.0-5.6 % 6.9 H It clearly suggests patient is
suffering from type 1 diabetes
that is accompanied by heart,
kidney diseases and damage of
nerve
Renal Function Panel
Sodium 136-145 mmol/L 117 L 137 Day 1 shows there are low sodium
levels present and this is called as

hyponatremia ,a condition low
sodium levels in blood region.
This results in kidney failure,
heart failure and cirrhosis. Later
on Day 3 due to increase in
sodium intake sodium levels
reached normal.
Potassium 3.5-5.0 mmol/L 3.9 4.3 Potassium levels are within
reference range and there is no
indication of high and low levels
of potassium based on assessment
carried out.
BUN 8-22 mg/dL 45 H 35 H Blood Urea nitrogen levels are
very high during day 1 and slightly
decrease on day 3 and this is
mainly due to improper
functioning of heart and
kidneys.
Creatinine 0.50-1.30 mg/dL 4.38 H 3.87 H Impairment of kidneys is
resulted due to high creatinine
levels and patient is suffering from
chronic kidney disease.
Glucose, Serum 60-125 mg/dL 580
HH
Based on results obtained it shows
patient glucose serum levels are
too high and reached abnormal
level leading to diabetes
condition
POC Glucose 141 Patient blood glucose levels are
high and experiencing
hyperglycemia
condition ,symptom of diabetes.
CBC
HGB 12.0-15.8 g/dL 7.1 L 8.5 L Patient is suffering from anemia
and nutrition deficiency of
vitamins like folic acid in their
regular diet.
HCT 35.9-48.7 % 21.2 L 27.1 L Results shows hematocrit test is
very low mainly due to lack of
supply of red blood cells leading
to anemia condition and also
causes leukemia or lymphoma