Ep 3:A 17-year-old with nausea and vomiting

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Every case has a script. Clinical approach is a collection of hypothetical case discussions with questions that test the key concepts for a particular disease presentation.

A 17-year-old girl with a history of Type I Diabetes Mellitus is brought to the Emergency Department with nausea, vomiting, lethargy, and dehydration. The mother reports that she stopped taking her insulin a day before the presentation. She is a thin woman in mild respiratory distress. Respiratory rate is 28 breaths per minute, Blood Pressure 80/40mmHg, Heart Rate 112 beats per minute, Temperature 37.2 C. There are normal heart sounds, the lungs are clear, the abdomen is soft, and there is no organomegaly. She is responsive and oriented to time, place, and person, but somnolent and weak. Mucous membranes are dry. These are her lab results: Serum sodium 126 (132 – 146) mEq/L, Potassium 4.3 (3.5 – 5.5) mEq/L, Magnesium 1.2 (1.3 – 2.1 ) mEq/L, BUN 76 (9-23 )mg/dl, Creatinine 2.2 (0.5 – 1.1) mg/dl, Bicarbonate 10 (22 – 25) mmol/L, Chloride 88 (99 – 109 ) mEq/L, Serum glucose 40 mmol/L (< 11 mmol/L)