23-year-old male with a history of type I diabetes presented…
23-year-old male with a history of type I diabetes presented to the emergency department due to a change in mental status. Nurses’ Notes 1200. 23-year-old male with a history of diabetes type I brought to the emergency department by spouse for changes in mental status from his baseline. The client’s wife reports that he woke at 0600 to complete his morning routine. At approximately 1100 he became unaware of his surroundings and began sweating profusely and slurring his words. Breath sounds are clear but noted with a fruity citrus odor and deep rapid respirations. Sinus tachycardia per cardiac monitor. He is awake and alert, pupils equal and reactive to light. Weight 205lbs (93kg) 1215. Voided 30mL dark amber urine sent for urinalysis. Comprehensive metabolic panel, CBC, and ABG. IV of normal saline started. Capillary glucose is 440. 1230 Transferred to ICU. IV fluids bolus given. 1300: Started on maintenance IV fluids and insulin drip. 1330: Capillary glucose 435. Awake, alert, oriented to person and place, talking in full complete sentences. Denies pain. Breath sounds are clear. Voided 300mL clear color urine. Vital Signs Time 1200 1215 1330 1330 Temp 99.5° F (37.5 °C) 99.5° F (37.5 °C) 98.9°F (37.1 °C) 98.9°F (37.1 °C) P 118 115 105 100 RR 32 30 30 24 B/P 89/52 92/56 100/70 109/70 Pulse oximeter 89% on RA 92% on 2L NC 94% on 2L NC 95% on 2L NC Medications Humalog insulin sliding scale with meals Lantus 10 units QHS Laboratory Report Lab Results 1200 Results 1400 Reference range ABG pH 7.20 7.3 7.35-7.45 ABG PC02 45 35 35-45 mmHg ABG HC03 32 24 22-26 mEq/L Anion Gap 26 18