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On the following pages are details of a fictional patient, complete with context, case history and test results. Your job is to diagnose the condition and suggest treatment options. Follow the instructions at the bottom of the article to submit your entry. Winners will receive a free training course. We will also publish a detailed review of the case study with an interpretation of the results on nursingtimes.net.
This 27-year-old Type 1 Diabetic was found unconscious, lying on his bedroom floor. He has been generally unwell recently with a gastrointestinal upset. His flat-mate said that his blood glucose levels had been running quite high for a couple of weeks and that he had not always been taking his prescribed insulin. He had been to quite a few parties in the last 2 weeks and had been drinking quite heavily at these events.
He is drowsy but rousable. He is tachypnoeic and there is a distinctive smell of ketones from his breath. He has peripheral cyanosis.
He is separated from his wife. He has two young children. He lives with a flat mate in rather run down rented accommodation. He works full time as a mechanical engineer.
Table 1: Vital signs on admission
90 / 45 mmHg
40 per minute
89% on 4 litres of oxygen
Random blood glucose
A 14FR gauge urinary catheter was inserted. He had about 100 mls of urine in his bladder.
A CVP line was inserted in his internal jugular vein. The initial recording was + 1mmHg
Table 2: Blood results
136 - 144
3.5 - 5.0
95 - 105
3.0 - 8.3
80 - 130
120 - 160
Mean Cell Volume
80 - 98
White Cell Count
4.0 - 11.0
Table 3: Results of arterial blood gas sample taken from radial artery
7.35 - 7.45
4.65 - 6.0 kilopascals
24 - 32
11.5 - 14 kilopascals
Please see the PDF of this case study to view the AP chest x-ray taken in the A&E department.
Answer to this case study
This patient has Diabetic Ketoacidosis. His blood glucose confirms hyperglycaemia and his ABG shows a metabolic acidosis. His CO2 level is low as he is tachypnoeic and attempting to eliminate acid by the respiratory system.