usmlebuzz
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A 9-month-old black male infant was brought to the emergency department by his mother. She complained that her son felt warm and had vomited 3 entire feedings during the last 12 hours. The mother stated that the infant had no diarrhea or decreased urine output but did have decreased appetite. The infant was crying but alert and consolable in his mother's arms. On questioning, the mother reported no history of polyuria, polydipsia, polyphagia, or weight loss. Vital signs were temperature, 37.5 degrees Celcius; pulse rate, 150/min; respiratory rate, 32/min; and weight, 9 kg. Physical examination was normal except for a fruity breath smell, dry mucous membranes, and a diaper rash consistent with dermal candidiasis. The fruity smell prompted a "finger-stick" blood glucose test, which indicated a high blood glucose level. Serum glucose analysis was requested, and the patient was started empirically on intravenous (IV) fluids, normal saline at 55 mL/hour (1.5 maintenance fluids).
Laboratory studies yielded the following values: white blood cell count, 11,400/mm3 with a normal differential; blood urea nitrogen, 13 mg/dL; creatinine, 0.8 mg/dL; sodium, 138 mmol/L; potassium, 4.8 mmol/L; chloride, 99 mmol/L; CO2, 11.3 mmol/L; and glucose, 1,000 mg/dL. Arterial blood gas values showed a pH of 7.21; Pco2, 19 mm Hg; Po2, 102 mm Hg; and bicarbonate, 8 mEq/L. Chest radiographs appeared normal. A bolus of normal saline (20 mL/kg) was given intravenously, after which IV fluids were continued at 100 mL/hour
what is the diagnosis
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diabetes presenting as DKA
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| usmlebuzz
Forum Elite
Topics: 93
Posts: 263
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 correct
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Hi, I thawt in DKA the blood glucose does not go that high. Unlike hyperosmolar coma, where the glucose is around 900-1000, thanx
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