A 21 year old noncomplaint male with a history of type I (insulin-dependent) diabetes mellitus was found in a coma. His blood glucose was high, as well as his urine glucose, urine ketones, and serum ketones. His serum bicarbonate was <12 mEq/L. His respiration was exaggerated and his breath had an acetone odor. His blood pressure was 90/60 and his pulse weak and rapid (120).
Diabetes - 6 Answers
Random Answers, Critics, Comments, Opinions :
1 :
ketoacidosis makes your breath have a fruity smell.And the increase of ketones in the blood is indicative of Ketoacidosis. It is as if there is too much glucose in the blood for the amount of insulin there is to interact with and the glucose goes sky high.
2 :
i think a doctor in the ER would have to make a diagnosis for him and treat him
3 :
diabetic coma with ketoacidosis.without insulin the body cells cannot metabolize glucose,the body needs glucose for energy,therefore the body compensates by breaking down fat or glycogen into glucose.However without the insulin the glucose just floats around in the blood,not being used.Ketones is a byproduct of fat breakdown and the ketones are acidic in nature,they cause a imbalance in the acid base balance of the blood.Fruity breath caused by acetone
4 :
Well, a nice question really. Since the patient is Type 1 or (Insulin Dependant Diabetes), : 1. He is at higher risk of Diabetic ketoacidosis, since these patients tend to have uncontrolled diabetes; primarily because they have almost complete absence of pancreatic Insulin. 2. For the same reason, he is not very much likely to go into insulin shock unles he messes with insulin dosing. Since we know that he is "non-compliant", it is likely that he skips doses rather than take them. This puts insulin over-dose out of question just on history alone. However, if any doubt remains, i guess that is cleared by his elevated blood glucose levels. Glucose will never be high with insulin over-dose. This definitely goes in favor of diabetic keto-acidosis. And with keton bodies in urine and blood stamps the diagnosis. (by effectively truling out one other heavy differential diagnosis of Non-ketotic hyperosmolar coma; however, this one is also ruled out by the fact that it is more common in Type 2 diabetes) You probably are confused just be "coma" presentation. while, infact it is true that coma can be a presenting feature of both insulin shock and diabetic ketoacidosis, the other features lead us to simple and plain diagnosis. - Diabetic ketoacidosis.(DKA) Note: Another good point in favor of DKA is the fact that he is over-ventilating (respiring). As long as he does that, it values little to debate over his breath's smell. Smell of his breath might have been an issue had we been considering Lactic acidosis (another one that might present as coma in diabetics). However, we cant give much attention to lactic acidosis as a differential because of the history again. Lactic acidosis affects patients who are type 2 and are taking oral anti0diabetic drugs like Metformin. Having said all that, Serum plasma osmolality, PH studies, Arterial blood gases, Blood urea studies, C-peptide levels , might be indicated. I hope that answers ur question.
5 :
Either way he should be in an emergency room if he was found in a coma. There could be any number of causes.
6 :
Someone in pre-med or pre-nursing needs their homework done for them, I presume. Tsk.
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