Diabetic Ketoacidosis (DKA) Case Study Analysis

Scenario:

You are working in an outpatient clinic when a mother brings in her 20-year-old daughter, C.J., who has type 1 diabetes mellitus (DM) and has just returned from a trip to Mexico. She has had a 3-day fever and diarrhea with nausea and vomiting. She has been unable to eat and has tolerated only sips of fluid. Because she was unable to eat, she did not take her insulin as directed. You note C.J. is unsteady, so you take her to the examining room in a wheelchair. While assisting her onto the examination table, you note her skin is warm and flushed. Her respirations are deep and rapid, and her breath is fruity and sweet smelling. C.J. is drowsy and unable to answer your questions. Her mother states, "She keeps telling me she's so thirsty, but she can't keep anything down."

Questions:

1.  List four pieces of additional information you need to elicit from C.J.'s mother.

Case Study Progress:

The mother tells you the following:
“Blood glucose monitor has been reading ‘high.’" “C.J. has had sips of ginger ale, but that’s all.” “She has been vomiting about every other time she drinks.” “When she first got home, she went [voided] a lot, but yesterday she hardly went at all, and I don't think she has gone today.” “She went to bed early last night, and I could hardly wake her up this morning. That's why I brought her in.”

Questions:

2.  Describe the pathophysiology of diabetic ketoacidosis (DKA).

Case Study Progress: Chart View:

3.  Interpret C.J.'s VS, relating your discussion to the underlying pathophysiology.

4.  Explain the rationale for C.J.'s other presenting signs and symptoms.

5.  Which of these ABG results would you expect to see in C.J.?
a. pH 7.40, Pao2 88, Paco2 34, HCO3 23
b. pH 7.48, Pao2 90, Paco2 30, HCO3 28
c. pH 7.27, Pao2 90, Paco2 50, HCO3 20
d. pH 7.26, Pao2 94, Paco2 23, HCO3 18

6.  When you attach C.J. to the cardiac monitor, which of the following would you expect to see on the ECG tracing?
a. Peaked P waves and a shortened PR interval
b. Presence of a U wave and ST segment depression
c. Tall, peaked T waves and widened QRS complexes
d. Narrow QRS complexes and shortening of the QT interval