Pre-Quiz: Hyperglycemic Crisis: Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome EM 201

A 28-year-old man with type 1 diabetes presents with polyuria, polydipsia, nausea, and vomiting for 2 days. Vital signs show blood pressure 118/76 mm Hg, heart rate 102 bpm, respiratory rate 24 breaths/min, and temperature 37.1°C (98.8°F). Physical exam is significant for dry oral mucosa and fruity breath odor. Laboratory results show venous blood pH 7.20, serum bicarbonate 12 mEq/L, anion gap 22, plasma glucose 480 mg/dL, and urine ketones 4+.

Which of the following is the most appropriate classification of this patient’s diabetic ketoacidosis (DKA) severity?

A 65-year-old woman with a history of type 2 diabetes presents with altered mental status, extreme thirst, and fatigue. Vital signs show blood pressure 152/88 mm Hg, heart rate 118 bpm, respiratory rate 22 breaths/min, temperature 37.3°C (99.1°F), and oxygen saturation 95% on room air. Physical exam reveals dry mucous membranes and poor skin turgor. Laboratory results are significant for serum glucose 850 mg/dL, serum osmolality 320 mOsm/kg, venous blood pH 7.35, serum bicarbonate 22 mEq/L, and negative serum and urine ketones.

Which of the following is the most likely diagnosis?

A 42-year-old man with type 1 diabetes is brought to the emergency department with confusion and vomiting. His wife reports he ran out of insulin 2 days ago. Vital signs show temperature 38.5°C (101.3°F), heart rate 112 bpm, blood pressure 98/58 mm Hg, and respiratory rate 28 breaths/min with deep, labored breathing. Laboratory results show venous blood pH 7.15, plasma glucose 650 mg/dL, serum bicarbonate 8 mEq/L, and positive serum and urine ketones.

Which of the following insulin regimens is most appropriate to initiate for this patient?

A 22-year-old woman with type 1 diabetes is admitted with diabetic ketoacidosis. Her blood glucose is initially 420 mg/dL. After starting an intravenous insulin infusion 6 hours ago, her blood glucose is now 168 mg/dL. Which of the following is the best action to take regarding her insulin infusion rate?

JH is a 48-year-old man who presents to the emergency department with the primary complaint of lethargy. For the past two weeks, he has been irregularly using a friend’s insulin pen without being able to specify the quantity or frequency of use. Shortly after his hospital admission, JH becomes unresponsive to verbal stimuli and only responds with moans after a deep sternal rub. Significant lab findings upon presentation include:

CHEMISTRY: Sodium 131mEq/L, Glucose 1588mg/dL, Chloride 106mEq/L, Potassium 4.2mEq/L, SCr 2.1mg/dL, BUN 33mg/dL, HCO3 21mEq/L, Plasma Osmolality (pOsm) 330mOsm/kg

CBC: WBC 6.1 x 103 cells/μl, Hgb 13.7g/dL, Hct 43.6%, Platelets 225,000/μl

URINALYSIS: RBC(-), WBC(-), LE(-), Ketones(-), Glucose (++)

ARTERIAL BLOOD GAS: pH 7.423

Based on JH’s clinical presentation and laboratory values, which of the following measurements most accurately reflects his current medical condition, and what is its calculated value?