29 year old female presents abdominal pain, nausea, vomiting, and confusion. Patient stated her nausea and abdominal discomfort began a few days ago and has progressively gotten worse. She states she is a diabetic and her sugars have been running high. She explains she was supposed to switch insulin regimens a week ago, but had some issues at the pharmacy and has continued on her previous regimen until those issues are resolved. She was diagnosed with diabetes 5 years ago following her first pregnancy in which she had gestational diabetes.
Weight: 80kg
PMH: Diabetes
Allergies: NKDA
Meds: 20 units NPH qd, NovoLog 13 units with meals, Prenatal Vitamin
VS: BP 110/70, HR 106, T99, RR16
PE:
CV: normal S1, S2, no MRG, 2+ peripheral pulses, no cyanois, cap refill < 2 secs
Pulm: lungs CTAB, normal work of breathing
Abdomen: soft, non-distended, mild tenderness to palpation, bowel sounds normative x 4
Neuro: mild confusion, appropriate deep tendon reflexes, cranial nerves intact
Skin: supple, moist, no rashes, ulcers, or lesions
HEENT: normocephalic atraumatic, nasal mucosa moist, nares patent, oropharynx pink and moist without erythema or exudate, trachea midline, no lymphadenopathy
Labs:
Hb: 12
Hct: 38
WBC: 14
Plt: 152
Na: 140
K: 3.5
Cl: 100
CO2: 28
BUN: 18
Cr: 0.9
Glu: 442
Serum Osm: 330
UA: negative (no WBC, no RBC, no Ketones, etc.)
Urine HCG: negative
Tests / Imaging:
KUB: no acute findings
CXR: no acute findings
EKG: sinus tachycardia
1. What is your differential diagnosis? (Will list some follow up questions about making a plan)
Weight: 80kg
PMH: Diabetes
Allergies: NKDA
Meds: 20 units NPH qd, NovoLog 13 units with meals, Prenatal Vitamin
VS: BP 110/70, HR 106, T99, RR16
PE:
CV: normal S1, S2, no MRG, 2+ peripheral pulses, no cyanois, cap refill < 2 secs
Pulm: lungs CTAB, normal work of breathing
Abdomen: soft, non-distended, mild tenderness to palpation, bowel sounds normative x 4
Neuro: mild confusion, appropriate deep tendon reflexes, cranial nerves intact
Skin: supple, moist, no rashes, ulcers, or lesions
HEENT: normocephalic atraumatic, nasal mucosa moist, nares patent, oropharynx pink and moist without erythema or exudate, trachea midline, no lymphadenopathy
Labs:
Hb: 12
Hct: 38
WBC: 14
Plt: 152
Na: 140
K: 3.5
Cl: 100
CO2: 28
BUN: 18
Cr: 0.9
Glu: 442
Serum Osm: 330
UA: negative (no WBC, no RBC, no Ketones, etc.)
Urine HCG: negative
Tests / Imaging:
KUB: no acute findings
CXR: no acute findings
EKG: sinus tachycardia
1. What is your differential diagnosis? (Will list some follow up questions about making a plan)
