A 19 year old female presents to the emergency department with hyperglycaemia and acute breathlessness. Diabetes was diagnosed 8 months previously and she is on treatment with insulin. She is also on the oral contraceptive pill.
On examination, she is clinically dehydrated. Blood pressure is 120/75 mmHg and her pulse is 130 bpm. Oxygen saturations are 96% on air. Respiratory rate is 32/min.
Initial investigations reveal the following:
Glucose 19.1 mmol/L
Hb 16.6 g/dL
Creatinine 89 umol/L (1.0 mg/dL)
Urinalysis: ketones ++++, glucose +++, nitrite – nil, leukocytes – nil
ABG on air: pH 7.3, pO2 10.2, pCO2 3.1, HCO3 11.3
How would you manage this woman in the ED?
What other tests would you like to perform?
There will be an update on this case for all of our MSc students later in the week.
Many thanks to Dr Debbie Wake for this case.