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Chief Complaint

“Too exhausted to go to soccer practice”

History of Present Illness

19-year-old male with fatigue, abdominal pain, nausea, vomiting, and tachypnea. Past medical history is significant for type 1 diabetes mellitus and depression.

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Missing Information?


Patient Database

Drug Therapy Problems

Care Plan (by Problem)


  1. What signs and symptoms of DKA are seen in this patient?

    Hint: See Treatment in PPP

  2. What is the mechanism for DKA onset and how do these pathophysiologic changes manifest as signs and symptoms of DKA?

    Hint: See Treatment in PPP

  3. What electrolyte disturbances would you anticipate in a patient presenting with DKA and how will these change with treatment?

    Hint: See Treatment in PPP

  4. In an appropriate order, which therapies should be provided to this patient to treat their DKA?

    Hint: See Treatment and Table 44-12 in PPP

  5. What criteria should be used to determine resolution of DKA?

    Hint: See Treatment and Table 44-12 in PPP


What other treatment and monitoring plans are available that the patient may be more likely to adhere to?

Hint: See Treatment in PPP


Global Perspective

The first human to receive exogenous insulin was a 14-year-old dying of diabetic ketoacidosis in a Toronto hospital in 1922 (ADA 2019). The patient recovered, and the world was changed forever. The researchers responsible for this breakthrough were awarded the Nobel Prize in Medicine one year later. Prior to the use of exogenous insulin to manage DKA, this condition was associated with 100% mortality rate (Poovazhagi 2014). In high-income countries, mortality from DKA is now between 0.15% - 0.31% (Poovazhagi 2014). Unfortunately, in developing countries, morbidity, and mortality from DKA remains much higher. In countries such as India, Pakistan, and Bangladesh, mortality from DKA ranges between 3.4-13.4% (Poovazhagi 2014). In sub-Saharan Africa, mortality rates as high as 26-29% have been reported (Iddi 2017).

Several challenges faced in the developing world have been identified as potential causes of this disparity, including delayed recognition and treatment of DKA, a lack of funding for the treatment of non-communicable diseases, and unreliable access to insulin (Kidie 2021). The prevalence of diabetes is increasing globally, and as such, the World Health Organization and United Nations have identified it as one of four priority non-communicable diseases (NCDs). Ambitious goals were set during the United Nations General Assembly’s 2030 Agenda for Sustainable Development, including a commitment by member countries to reduce premature mortality from NCDs by 33%, to achieve universal health coverage, and to provide access to affordable essential medications, ...

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