Algorithm for the Management of Diabetic Ketoacidosis
- American Diabetes Association From Diabetes Care Vol 29, Issue 12, 2006. Modifications from Diabetes Care, Vol 32, Issue 7, 2009.
- WikEM: Diabetic ketoacidosis
Blurred vision, numbness
56 year-old male with a history of DM, questionable HTN presenting with blurred vision, numbness of fingertips/toes for 2wks. Associated symptoms include dry mouth, polydipsia/polyuria. He states that these symptoms coincide with elevated measurements of blood glucose at home (>500). He ran out of his diabetes medication (metformin) 8mo ago but states his BG was typically between 100-200 with diet/exercise until 2wks ago. He reports recent dietary indiscretions on a trip to Las Vegas.
He denies fevers/chills, CP/SOB, cough, abdominal pain, N/V, or dysuria.
Several maternal family members with DM.
|VS:||T 37.8 HR 60 RR 14 BP 165/90 O2 99% RA|
|Gen:||Well-appearing, no acute distress, obese|
|HEENT:||PERRL, EOMI, optic discs sharp b/l, no abnormalities visualized|
|CV:||RRR, normal S1/S2, no M/R/G, no additional heart sounds|
|Lungs:||CTAB, no wheezes/crackles|
|Abd:||+BS, soft, NT/ND, no rebound/guarding|
|Ext:||Warm, well-perfused, 2+ pulses, no clubbing/cyanosis/edema|
|Neuro:||AAOx3, CN II-XII intact|
56M, hx DM with poor medication adherence presenting with vision changes and stocking/glove paresthesias for 2wks after reported dietary indiscretion found to be hyperglycemic. DKA/HHS unlikely given stable vital signs, normal metabolic panel with exception of isolated hyperglycemia (slight hyponatremia likely related to osmotic effect of elevated serum glucose). Also, no evidence of concerning precipitates for hyperglycemic crisis (no CP/SOB, no F/C, no cough, no abdominal pain, no change in mental status). Patient was discharged home with education on importance of medication adherence, refill of metformin, and follow-up with primary care physician for further management of DM and possible hypertension.
|Delta gap (AG-12)||17||11|