Chapter·ManagementDKA

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1

A 27-year-old man with a past medical history of type I diabetes mellitus presents to the emergency department with altered mental status. The patient was noted as becoming more lethargic and confused over the past day, prompting his roommates to bring him in. His temperature is 99.0°F (37.2°C), blood pressure is 107/68 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. Laboratory values are ordered as seen below. Serum: Na+: 144 mEq/L Cl-: 100 mEq/L K+: 6.3 mEq/L HCO3-: 16 mEq/L BUN: 20 mg/dL Glucose: 599 mg/dL Creatinine: 1.4 mg/dL Ca2+: 10.2 mg/dL Which of the following is the appropriate endpoint of treatment for this patient?

AClinically asymptomatic

BNormal anion gap

CNormal glucose

DVitals stable

ENormal potassium

2

A 65-year-old man is brought to the emergency department from his home. He is unresponsive. His son requested a wellness check because he had not heard from his father in 2 weeks. He reports that his father was sounding depressed during a telephone call. The paramedics found a suicide note and a half-empty bottle of antifreeze near the patient. The medical history includes hypertension and hyperlipidemia. The vital signs include: blood pressure 120/80 mm Hg, respiratory rate 25/min, heart rate 95/min, and temperature 37.0°C (98.5°F). He is admitted to the hospital. What do you expect the blood gas analysis to show?

ANon-anion gap metabolic acidosis

BMetabolic alkalosis

CRespiratory acidosis

DAnion gap metabolic acidosis

EMixed acid-base disorder

3

A 60-year-old homeless man presents to the emergency department with an altered mental status. He is not answering questions. His past medical history is unknown. A venous blood gas is drawn demonstrating the following. Venous blood gas pH: 7.2 PaO2: 80 mmHg PaCO2: 80 mmHg HCO3-: 24 mEq/L Which of the following is the most likely etiology of this patient's presentation?

AHeroin overdose

BCOPD

CEthylene glycol intoxication

DAspirin overdose

EDiabetic ketoacidosis

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