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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Recognize the signs and symptoms of diabetic ketoacidosis (DKA)

  • Identify the goals of therapy for the treatment of DKA and type 1 diabetes mellitus (T1DM)

  • Develop an appropriate treatment and monitoring plan for DKA using individual patient characteristics

  • Properly educate a patient newly diagnosed with T1DM to prevent possible future incidents of DKA

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PATIENT PRESENTATION

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Chief Complaint

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"I've been vomiting for 2 days."

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History of Present Illness

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Jimmy Wilkinson is a 20-year-old Caucasian male university student with known T1DM who comes into the emergency department with a 2-day history of N/V. Two weeks ago, he noticed that he was drinking water and urinating more frequently than usual. He also mentions that recently he has been having some difficulty waking up in the morning and staying awake and alert throughout the day. These symptoms began 2 weeks ago and have gotten progressively worse. He mentions that he has been feeling "a bit down" since his last round of final examinations approximately 3 weeks ago. When asked about his insulin therapy, he states that he "has not felt like using it for a while." He came to the emergency department after he missed 2 days of school and work due to N/V. He states that he has not been able to eat or drink without vomiting for about 36 hours. He reports that he has not seen his home physician in 8 months, and he does not currently have a primary care provider on campus. He is currently insured through the university's campus insurance plan. He denies any recent history of weight loss, diarrhea, changes in vision, or dysuria.

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Past Medical History

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Type 1 DM

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Major depressive disorder

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Seasonal allergic rhinitis

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Tonsillectomy at age 4 years

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Family History

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Father is alive at age 43 and has a history of T1DM, hypertension, and hyperlipidemia. Uncle on father's side is alive at age 50 and has a history of T1DM and stroke. Grandfather on father's side died at age 63 of MI. He had a history of T1DM. Mother is alive at age 38 with a major depressive disorder and systemic lupus erythematous.

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Social History

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Currently a junior in college and has a part-time job at a book store.

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Tobacco/Alcohol/Substance Use

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Admits to occasional alcohol and marijuana use at social gatherings; denies use of tobacco and other illicit drugs.

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Allergies/Intolerances/Adverse Drug Events

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NKDA

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Medications Prior to Admission

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Loratadine 10 mg PO daily

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Diphenhydramine 50 mg PO every 6 to 8 hours PRN allergies

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Fluticasone one spray each nostril ...

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