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diagnosis
#1
Dear members,

Hi,
An 18-year-old female was taken to the emergency room in coma. Her parents noticed that she had polydipsia, polyuria, and rapid weight loss which started approximately 1 month ago and had worsened in the last week. She had not been taking any medications and the clinical history was otherwise unremarkable. On examination, breathing was deep and rapid (Kussmaul respiration), pulse rate was 100 beats per minute, and blood pressure 110/70 mmHg; she also had signs of dehydration. She was drowsy and confused. Rapid hematology and biochemical tests showed hematocrit 44%, hemoglobin 13 g/dl (140 g/L), white blood cell count 12,000/ μl, glucose 520 mg/dl (28.9 mmol/L), urea 50 mg/dl (8.5 mmol/L), creatinine 0.8 mg/dl (70.7 μmol/L), Na+ 148 mEq/L, K+ 4.6 mEq/L, PO4 3-2.0 mEq/L (0.64 mmol/L), and Cl− 112 mmol/L. Arterial pH was 7.0, PO 2 98 mmHg, PCO 2 25 mmHg, HCO 3−12 mEq/L, and O 2 sat 98%.

[b]What is your diagnosis??And what do you recommend ?[/b]
TQ
Reply
#2
(09-14-2016, 04:36 PM)Dr. Arash Seyednia Wrote: Dear members,

Hi,
An 18-year-old female was taken to the emergency room in coma. Her parents noticed that she had polydipsia, polyuria, and rapid weight loss which started approximately 1 month ago and had worsened in the last week. She had not been taking any medications and the clinical history was otherwise unremarkable. On examination, breathing was deep and rapid (Kussmaul respiration), pulse rate was 100 beats per minute, and blood pressure 110/70 mmHg; she also had signs of dehydration. She was drowsy and confused. Rapid hematology and biochemical tests showed hematocrit 44%, hemoglobin 13 g/dl (140 g/L), white blood cell count 12,000/ μl, glucose 520 mg/dl (28.9 mmol/L), urea 50 mg/dl (8.5 mmol/L), creatinine 0.8 mg/dl (70.7 μmol/L), Na+ 148 mEq/L, K+ 4.6 mEq/L, PO4 3-2.0 mEq/L (0.64 mmol/L), and Cl− 112 mmol/L. Arterial pH was 7.0, PO 2 98 mmHg, PCO 2 25 mmHg, HCO 3−12 mEq/L, and O 2 sat 98%.

[b]What is your diagnosis??And what do you recommend ?[/b]
TQ
Hi Dr. Arash,
The patient has marked hyperglycemia and metabolic acidosis. The diagnosis of newly diagnosed type 1 diabetes presenting with DKA should be considered.
Reply
#3
(09-14-2016, 11:46 PM)Dr. Shahrzad Bidar Wrote:
(09-14-2016, 04:36 PM)Dr. Arash Seyednia Wrote: Dear members,

Hi,
An 18-year-old female was taken to the emergency room in coma. Her parents noticed that she had polydipsia, polyuria, and rapid weight loss which started approximately 1 month ago and had worsened in the last week. She had not been taking any medications and the clinical history was otherwise unremarkable. On examination, breathing was deep and rapid (Kussmaul respiration), pulse rate was 100 beats per minute, and blood pressure 110/70 mmHg; she also had signs of dehydration. She was drowsy and confused. Rapid hematology and biochemical tests showed hematocrit 44%, hemoglobin 13 g/dl (140 g/L), white blood cell count 12,000/ μl, glucose 520 mg/dl (28.9 mmol/L), urea 50 mg/dl (8.5 mmol/L), creatinine 0.8 mg/dl (70.7 μmol/L), Na+ 148 mEq/L, K+ 4.6 mEq/L, PO4 3-2.0 mEq/L (0.64 mmol/L), and Cl− 112 mmol/L. Arterial pH was 7.0, PO 2 98 mmHg, PCO 2 25 mmHg, HCO 3−12 mEq/L, and O 2 sat 98%.

[b]What is your diagnosis??And what do you recommend ?[/b]
TQ
Hi Dr. Arash,
The patient has marked hyperglycemia and metabolic acidosis. The diagnosis of newly diagnosed type 1 diabetes presenting with DKA should be considered.
Thanks so much Dr. Bidar for your time ,

DO you think any Additional biochemical tests are required to confirm the diagnosis?
Reply
#4
(09-15-2016, 01:43 AM)Dr. Arash Seyednia Wrote:
(09-14-2016, 11:46 PM)Dr. Shahrzad Bidar Wrote:
(09-14-2016, 04:36 PM)Dr. Arash Seyednia Wrote: Dear members,

Hi,
An 18-year-old female was taken to the emergency room in coma. Her parents noticed that she had polydipsia, polyuria, and rapid weight loss which started approximately 1 month ago and had worsened in the last week. She had not been taking any medications and the clinical history was otherwise unremarkable. On examination, breathing was deep and rapid (Kussmaul respiration), pulse rate was 100 beats per minute, and blood pressure 110/70 mmHg; she also had signs of dehydration. She was drowsy and confused. Rapid hematology and biochemical tests showed hematocrit 44%, hemoglobin 13 g/dl (140 g/L), white blood cell count 12,000/ μl, glucose 520 mg/dl (28.9 mmol/L), urea 50 mg/dl (8.5 mmol/L), creatinine 0.8 mg/dl (70.7 μmol/L), Na+ 148 mEq/L, K+ 4.6 mEq/L, PO4 3-2.0 mEq/L (0.64 mmol/L), and Cl− 112 mmol/L. Arterial pH was 7.0, PO 2 98 mmHg, PCO 2 25 mmHg, HCO 3−12 mEq/L, and O 2 sat 98%.

[b]What is your diagnosis??And what do you recommend ?[/b]
TQ
Hi Dr. Arash,
The patient has marked hyperglycemia and metabolic acidosis. The diagnosis of newly diagnosed type 1 diabetes presenting with DKA should be considered.
Thanks so much Dr. Bidar for your time ,

DO you think any Additional biochemical tests are required to confirm the diagnosis?

In this case I believe that determination of ketone bodies in blood or urine is necessary to confirm ketosis. In this case the strip for ketones in the urine was strongly positive and determination of β-OHB in serum was 4.0 mmol/L. Thus, the patient has the triad of hyperglycemia, ketosis, and acidosis and the diagnosis of DKA is confirmed.
Reply
#5
(09-15-2016, 02:14 AM)Dr.Sara Lotfi Wrote:
(09-15-2016, 01:43 AM)Dr. Arash Seyednia Wrote:
(09-14-2016, 11:46 PM)Dr. Shahrzad Bidar Wrote:
(09-14-2016, 04:36 PM)Dr. Arash Seyednia Wrote: Dear members,

Hi,
An 18-year-old female was taken to the emergency room in coma. Her parents noticed that she had polydipsia, polyuria, and rapid weight loss which started approximately 1 month ago and had worsened in the last week. She had not been taking any medications and the clinical history was otherwise unremarkable. On examination, breathing was deep and rapid (Kussmaul respiration), pulse rate was 100 beats per minute, and blood pressure 110/70 mmHg; she also had signs of dehydration. She was drowsy and confused. Rapid hematology and biochemical tests showed hematocrit 44%, hemoglobin 13 g/dl (140 g/L), white blood cell count 12,000/ μl, glucose 520 mg/dl (28.9 mmol/L), urea 50 mg/dl (8.5 mmol/L), creatinine 0.8 mg/dl (70.7 μmol/L), Na+ 148 mEq/L, K+ 4.6 mEq/L, PO4 3-2.0 mEq/L (0.64 mmol/L), and Cl− 112 mmol/L. Arterial pH was 7.0, PO 2 98 mmHg, PCO 2 25 mmHg, HCO 3−12 mEq/L, and O 2 sat 98%.

[b]What is your diagnosis??And what do you recommend ?[/b]
TQ
Hi Dr. Arash,
The patient has marked hyperglycemia and metabolic acidosis. The diagnosis of newly diagnosed type 1 diabetes presenting with DKA should be considered.
Thanks so much Dr. Bidar for your time ,

DO you think any Additional biochemical tests are required to confirm the diagnosis?

In this case I believe that determination of ketone bodies in blood or urine is necessary to confirm ketosis. In this case the strip for ketones in the urine was strongly positive and determination of β-OHB in serum was 4.0 mmol/L. Thus, the patient has the triad of hyperglycemia, ketosis, and acidosis and the diagnosis of DKA is confirmed.

Thank you so much Dr.bidar and Dr.lofti
I am concern that How will this patient  can be manage ?
Reply
#6
(09-15-2016, 03:09 AM)Dr. Arash Seyednia Wrote:
(09-15-2016, 02:14 AM)Dr.Sara Lotfi Wrote:
(09-15-2016, 01:43 AM)Dr. Arash Seyednia Wrote:
(09-14-2016, 11:46 PM)Dr. Shahrzad Bidar Wrote:
(09-14-2016, 04:36 PM)Dr. Arash Seyednia Wrote: Dear members,

Hi,
An 18-year-old female was taken to the emergency room in coma. Her parents noticed that she had polydipsia, polyuria, and rapid weight loss which started approximately 1 month ago and had worsened in the last week. She had not been taking any medications and the clinical history was otherwise unremarkable. On examination, breathing was deep and rapid (Kussmaul respiration), pulse rate was 100 beats per minute, and blood pressure 110/70 mmHg; she also had signs of dehydration. She was drowsy and confused. Rapid hematology and biochemical tests showed hematocrit 44%, hemoglobin 13 g/dl (140 g/L), white blood cell count 12,000/ μl, glucose 520 mg/dl (28.9 mmol/L), urea 50 mg/dl (8.5 mmol/L), creatinine 0.8 mg/dl (70.7 μmol/L), Na+ 148 mEq/L, K+ 4.6 mEq/L, PO4 3-2.0 mEq/L (0.64 mmol/L), and Cl− 112 mmol/L. Arterial pH was 7.0, PO 2 98 mmHg, PCO 2 25 mmHg, HCO 3−12 mEq/L, and O 2 sat 98%.

[b]What is your diagnosis??And what do you recommend ?[/b]
TQ
Hi Dr. Arash,
The patient has marked hyperglycemia and metabolic acidosis. The diagnosis of newly diagnosed type 1 diabetes presenting with DKA should be considered.
Thanks so much Dr. Bidar for your time ,

DO you think any Additional biochemical tests are required to confirm the diagnosis?

In this case I believe that determination of ketone bodies in blood or urine is necessary to confirm ketosis. In this case the strip for ketones in the urine was strongly positive and determination of β-OHB in serum was 4.0 mmol/L. Thus, the patient has the triad of hyperglycemia, ketosis, and acidosis and the diagnosis of DKA is confirmed.

Thank you so much Dr.bidar and Dr.lofti
I am concern that How will this patient  can be manage ?
Dear Dr.Arash
Urgent administration of intravenous fluid and insulin should begin together with careful monitoring, replacement of electrolytes, and correction of acidosis. After resolution of DKA and as long as the patient is conscious, feeding can start. Transition from intravenous to subcutaneous insulin administration should begin. A bolus of rapid-acting insulin should be administered subcutaneously based on the results of the fingerstick test 1-2 hours before discontinuation of intravenous insulin. A total daily dose of insulin of 0.5-0.8 IU/kg is required, divided as 30-50% basal insulin and the remainder as rapid-acting insulin before each meal.
Good luck 
Reply
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Sequined Sleeveless Maxi Prom Dress ( 57.23 $)
[Image: Sequined_Sleeveless_Maxi_Prom_DressFG.jpg]
Sequined Sleeveless Maxi Prom Dress ...
Fit: Plus Size
Style: A Line
Occasion: Formal
Material: Polyester
Composition: 100% Polyester
Dresses Length: Floor-Length
Neckline: Round Collar
Sleeve Length: Sleeveless
Embellishment: Sequined
Pattern

[Image: 2hs46dw.png]


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[Image: 14.jpg]
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#9
Ourtime X01S 3G Smartwatch Phone ( 93.30 $)
[Image: Ourtime_X01S_3G_Smartwatch_Phone9O.jpg]
Ourtime X01S 3G Smartwatch Phone ...
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[Image: 32.jpg]
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#10
Lenovo Lemo K3 (K30-w) Android 4.4 4G Smartphone ( 91.39 $)
[Image: Lenovo_Lemo_K3_(K30-w)_Android_4.4_4G_Smartphonerl.jpg]
Lenovo Lemo K3 (K30-w) Android 4.4 4G Smartphone ...
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[Image: 14.jpg]
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