Sallie is a 15-year-old female that is brought to the emergency room by her frig

Question

Sallie is a 15-year-old female that is brought to the emergency room by her frightened gym teacher. Sallie was playing soccer outside and had a syncopal episode. Sallie is now conscious but is breathing very fast, complains of being very thirsty and feeling very nauseous. On assessment you notice that her skin is redder than usual, dry and hot to the touch.

Lab values:

Na 138, K 5.5, Cl 105,

Glucose 575

pH 7.25,

CO2 30,

HCO3 8.0

1. Evaluate the lab values (normal, high, low)

Na: Normal (Between 135 and 145mEq/L)

K: High (Normal 3.5-5.0 mEq/L)

Cl: Normal (between 96 and 106mEq/L)

Glucose: High (Normal 70-100 mg/dL)

pH: Low (Normal 7.35-7.4)

CO2: High (Normal 23-29mEq/L)

HCO3: Low (Normal 22-28 mE

2. List 3 differential diagnoses and include your reasoning behind each.

3. What is the best diagnosis? Explain how you came to this conclusion.

4. What other findings may be present with this patient?

Explanation / Answer

1. Na: Normal (Between 135 and 145mEq/L)

K: High (Normal 3.5-5.0 mEq/L)

Cl: Normal (between 96 and 106mEq/L)

Glucose: High (Normal 70-100 mg/dL)

pH: Low (Normal 7.3 -7.4)

CO2: High (Normal 23-29mEq/L)

HCO3: Low (Normal 22-28 mE)

2. List 3 Differential diagnoses and include your reasoning behind each.

The doctor might ask to check whether she is diabetic or not since the blood sugar is abnormally high. The differential diagnosis for abnormal high sugar is Insulin resistance, Type 1 DM or Type 2 DM.

3. What is the best diagnosis? Explain how you came to this conclusion,

The best diagnosis is she has DM since the blood sugar is abnormally high. followed by high CO2 and Low HCO3.

4. The doctor can perfom Tilt table test and Holter monitor test since she has hyperventilation.

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