SAQ 1211 – Diabetic patient with severe biochemical derangement

A 58-year-old insulin-treated diabetic man presents confused and combative with severe biochemical derangement. HR is 140/min, BP 100/80, RR 32/min, SaO2 95%, estimated weight 70 kg. His results are shown below.

Test	Result	Reference range
pH	6.84	7.35-7.45
pCO2	8.7 mmHg	35-45
pO2	80 mmHg	95-100
HCO3	1.4 mmol/L	22-24
Na	126 mmol/L	135-145
K	5.5 mmol/L	3.5-4.5
Cl	98 mmol/L	95-110
Urea	20 mmol/L	2.9-7.1
Creatinine	150 umol/L	45-90
Lactate	4.1 mmol/L	<2.0
Glucose	54 mmol/L	3.5-6.0

What reservations do you have about intubating him on arrival?

(Marked out of 2.0)

/ 2

What are the complications from his condition?

(Marked out of 3.0)

/ 3

Outline your strategy for managing hypovolaemia, including volume, rate, fluid type and titration points.

(Marked out of 5.0)

/ 5

What electrolyte deficits exist? Include the magnitude of deficit.

(Marked out of 6.0)

/ 6

When do you need to start insulin?

(Marked out of 1.0)

/ 1

What dose of insulin would you use?

(Marked out of 1.0)

/ 1

Name two (2) potential causes of his condition.

(Marked out of 2.0)

/ 2

Total Score: 0 / 20

Percentage: 0%