BOF: 9
A 50-year-old male is brought into the casualty ward
having been found unconscious by his son.
He is a known insulin dependent diabetic who has not been
taking his medication on a regular basis. He does not attend follow up or see
his GP on a regular basis.
On examination he is febrile, has decreased skin turgor,
pulse rate 120 beats per minute BP 90/70 he has deep sighing respiration but
lungs are clear. He is drowsy but responds to pain, no neck stiffness or
Kernig’s sign. There is cellulitis of his right lower limb.
Investigations:
Hb 14.5g/dL
WBC 17.4x 109/L
Blood urea 12.4 mmol/L
Creatinine 114 micromoles/L
Blood gases pH 7.1, pa CO2 3.0 kPa, paO2
12.5 kPa
In this patient your first step in management would be:
a)
Start up an infusion of 0.9% sodium chloride
b)
Start the patient on intravenous broad spectrum antibiotics
c)
Start the patient on low dose intravenous insulin
d)
Treat with intravenous bicarbonate
e)
Insert a nasogastric tube to prevent aspiration pneumonia
Answer: a)
The patient has diabetic ketoacidosis. In this condition
the most important step in management is replacement of the massive
electrolyte and fluid deficit that occurs in these patents.
Revision Tip
Revise diabetic ketoacidosis KEYS to SUCCESS in Medicine
pages 38-40
