Mr. P, A 27 Year Old African American Man - 1308 Words

Case Study Mr. P, a 27-year-old African American man, was brought to the emergency department (ED) by his wife. The patient reported polyuria for the past three days, few episodes of vomiting prior to arrival and polydipsia. On assessment, the patient appears flushed, and his lips and mucous membranes are dry and cracked. His skin turgor is very poor. He has deep, rapid respirations and there is an acetone smell to his breath. He is alert and oriented X 2 and is having trouble focusing on the questions. The wife reported Mr. P was diagnosed with type 1 diabetes mellitus 6 months ago. Additionally, he had the flu for one week with increased vomiting and anorexia and stopped taking insulin three days ago because he was unable to eat. Mr. P’s vital signs and diagnostic studies are as follows: Blood glucose level 700mg/dL, Blood Pressure 90/60mm Hg, Heart Rate 128 beats/min, Respiratory Rate 34 breaths/min, Temperature 100.8 F, Serum pH 7.26, Serum HCO3 10 mEq/L, BUN 40 and Creatinine 3.5. Pathophysiology DKA is presented with three major physiological disturbances which are hyperosmolality due to hyperglycemia, metabolic acidosis because of the buildup of ketoacids, and hypovalemia from osmotic diuresis. Diabetic ketoacidosis is caused by a profound deficiency of insulin, its most likely occur in people with type 1 diabetes, inadequate insulin dosage, poor self management, undiagnosed type 1 diabetes, illnesses and infections. 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