Daniel Purcel was diagnosed with type 1 diabetes mellitus whenhe was 12 years old. He is now a nursing student. He has managed tocontrol his diabetes throughout school. However, when he began hisclinicals, his regular schedule of meals and insulin injections wascompletely disrupted. One morning, Daniel completely forgot to takehis insulin. At 7am he drank orange juice and ate two doughnuts. At8am he drank more juice because he was very thirsty. He mentionedto a fellow student that he felt confused, weak, and that his heartwas racing. At 9:06 am, he fell unconscious. He was transferredimmediately to the emergency room, where the following informationwas obtained:
Blood pressure: 90/40
Pulse: 130, regular, strong
Respirations: 32, regular rhythm, deep, labored (“Kussmaul”) Plasmaglucose: 560 mg/dL (normal fasting 70-110 mg/dL) Plasma HCO3-: 8mEq/L (normal 24 mEq/L)
Plasma ketones: ++ (normal none)
Arterial PO2: 112 mmHg (normal 100 mmHg)
Arterial PCO2: 20 mmHg (normal 40 mmHg)
Arterial pH: 7.22
The physician determined that Daniel was in diabeticketoacidosis. He was given an intravenous infusion of isotonicsaline and insulin. Later, after his blood glucose had decreased to175 mg/dL, glucose was added to the infusion. Daniel stayed in thehospital overnight. By the next morning, his blood glucose,electrolytes, and blood gas values were normal.
Questions:
18.Which acid-base disorder did Daniel have? What caused it? Whydid he present with Kussmaul respirations? Explain these all in thecontext of the laboratory test results.
19.How did Daniel’s failure to take insulin cause this acid-basedisorder?
20.Explain Daniel’s thirst, low blood pressure, tachycardia,confusion, and weakness.
21.Explain the basis for the treatments provided (saline,insulin, and glucose).
