Post-Quiz: Hyperglycemic Crisis: Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome

A 22-year-old male with a five-year history of type 1 diabetes presents to the emergency department with nausea, severe abdominal pain, and altered mental status that has been worsening over the past 24 hours. His blood glucose at home was too high for his glucometer to read. He has been compliant with his insulin regimen. On exam, he appears dehydrated and is breathing rapidly. His lab results show a blood glucose level of >600 mg/dL, arterial pH of 7.2, serum bicarbonate of 10 mEq/L, positive urine and serum ketones, and a serum potassium of 3.8 mmol/L. What is the most appropriate initial management strategy for this patient?

A 56-year-old male with a history of long-term glucocorticoid therapy presents to the Emergency Department with severe abdominal pain, nausea, vomiting, dizziness, and a reported history of bacterial pneumonia five days prior. His vital statistics are as follows: blood pressure – 60/40 mmHg; pulse – 120 bpm; temperature – 97 F, and respiratory rate – 30 bpm. He appears confused and lethargic. Laboratory investigations reveal a serum cortisol level of 16 mcg/dl (normal range 5-25 mcg/dL), sodium 134 mEq/L and a serum potassium of 5.5 mmol/L.

What is the most accurate diagnosis for the patient’s condition based on the symptoms presented?

A 55-year-old man with a history of type 2 diabetes presents to the emergency department with altered mental status, polyuria, and severe dehydration. His blood glucose level is 800 mg/dL, and his serum osmolality is 320 mOsm/kg. He is diagnosed with hyperosmolar hyperglycemic state (HHS). Which of the following is the most appropriate initial management strategy?

A 45-year-old woman with a history of type 1 diabetes presents to the emergency department with symptoms of polyuria, polydipsia, and fatigue. Her blood glucose level is 550 mg/dL, and her arterial blood gas shows a pH of 7.2. Based on the following laboratory results, calculate the anion gap:

Sodium: 140 mEq/L

Potassium: 5 mEq/L

Chloride: 100 mEq/L

Bicarbonate: 10 mEq/L

What is the calculated anion gap?

A 45-year-old woman with a history of type 1 diabetes presents to the emergency department with symptoms of polyuria, polydipsia, and fatigue. Her blood glucose level is 550 mg/dL, and her arterial blood gas shows a pH of 7.2. Based on the following laboratory results, calculate the anion gap:

Sodium: 140 mEq/L

Potassium: 5 mEq/L

Chloride: 100 mEq/L

Bicarbonate: 10 mEq/L

What is the calculated anion gap?

 AP, a 47-year-old male with past medical history of type II diabetes, hypertension and osteoarthritis presents to the emergency department complaining of lethargy and drowsiness. He is noncompliant with his medications. Initial glucometer reading simply reads “HIGH”. Notable subsequent laboratory results are as follows:

CHEMISTRY: Sodium (Na+) 125mEq/L, Glucose 745mg/dL, Chloride (Cl-) 101mEq/L, Potassium (K+) 3.0mEq/L, Serum Creatinine (SCr) 1.6mg/dL, Blood Urea Nitrogen (BUN) 18mg/dL, Bicarbonate (HCO3-) 9mEq/L, Albumin 3.3g/dL

Complete Blood Count (CBC): White Blood Cells (WBC) 8.2 x 103 cells/μl, Hemoglobin (Hgb) 13.5g/dL, Hematocrit (Hct) 41.6%, Platelets 210,000/μl

URINALYSIS: Red Blood Cells (RBCs) Negative, White Blood Cells (WBCs) Negative, Leukocyte Esterase (LE) Negative, Ketones Positive, Glucose 2+

ARTERIAL BLOOD GAS: pH 7.122

Based on the results of the chemistry panel, calculate AP’s anion gap.

AP is a 46-year-old male presenting to the emergency department with a chief complaint of lethargy and history of type II diabetes, hypertension, and osteoarthritis. A glucometer check reads “HIGH”, and labs indicate:

CHEMISTRY: Sodium 125mEq/L, Glucose 745mg/dL, Chloride 101mEq/L, Potassium 3.0mEq/L, SCr 1.6mg/dL, BUN 18mg/dL, HCO3 9mEq/L, Albumin 3.3g/dL

CBC: WBC 8.2 x 103 cells/μl, Hgb 13.5g/dL, Hct 41.6%, Platelets 210,000/μl

URINALYSIS: RBC(-), WBC(-), LE(-), Ketones(+), Glucose (++)

ARTERIAL BLOOD GAS: pH 7.122

On follow-up, the chemistry panel displays: Sodium 136mEq/L, Glucose 187mg/dL, Chloride 104mEq/L, Potassium 4.2mEq/L, SCr 1.2mg/dL, BUN 14mg/dL, HCO3 20mEq/L.

What should be the next step in medication therapy and when should therapy end?