A 21-year-old noncompliant female with a history of type I (insulin-dependent) d

Question

A 21-year-old noncompliant female with a history of type I (insulin-dependent) diabetes mellitus was found in a coma. Her blood glucose was high, as well as her urine glucose, urine ketones, and serum ketones. Her serum bicarbonate was < 12 mEq/L. Her respiration was exaggerated and his breath had an acetone odor. Her blood pressure was 90/60 and his pulse weak and rapid (120). 1. Define noncompliant. 2. Is this person experiencing ketoacidosis or insulin shock? Explain your answer. 3. Why is the serum bicarbonate low? 4. What is the acid-base status of this individual? 5. What is the cause of the dyspnea, hypotension, and tachycardia? 6. What type of treatment does this person need?

Explanation / Answer

1) Noncompliant is the failure or refusal to comply (as in the taking of prescribed medication).

2)

3) The serum bicarbonate is low due to the buffering of the keto acids by the bicarbonate ions.

4) This is an example of metabolic acidosis.

5) Dyspnea is caused by the acidosis, which stimulates the respiratory center, producing the rapid, deep respiration known as Kussmaul breathing (as described by Kussmaul). Hypotension is caused by fluid loss from an osmotic diuresis (glucose loss in the urine). Tachycardia is a reflex response in an attempt to overcome the hypotension.

6) This person needs a rapid-acting insulin and IV fluids in the form of 0.9% sodium chloride (plus bicarbonate if the blood pH is <7.1 and the serum bicarbonate is <10 mEq/L). (There are approximately seven forms of insulin currently available in the United States with different rates of onset, effectiveness, and duration of action. They are generally classified into rapid-, intermediate-, and long-acting insulins.)

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