Group Diabetes Case Study Use the case study below to answer ✓ Solved

A 21-year-old female (A.M) presents to the urgent care clinic with symptoms of nausea, vomiting, diarrhea, and a fever for 3 days. She states that she has Type I diabetes and has not been managing her blood sugars since she’s been ill and unable to keep any food down. She’s only tolerated sips of water and juices. Since she’s also been unable to eat, she hasn’t taken any insulin as directed.

While helping A.M. from the lobby to the examining room you note that she’s unsteady, note that her skin is warm and flushed and that she’s drowsy. You also note that she’s breathing rapidly and smell a slight sweet/fruity odor. A.M. has a challenge answering questions but keeps asking for water to drink. You get more information from A.M. and learn:

  • She had some readings on her glucometer which were reading ‘high’.

  • She vomits almost every time she takes in fluid.

  • She hasn’t voided for a day but voided a great deal the day before.

  • She’s been sleeping long hours and finally woke up this morning and decided to seek care.

Current labs and vital signs:

Summarize the questions above and formulate what may be happening with A.M. and how you would improve her condition. Use three evidence-based articles from peer-reviewed journals or scholarly sources to support your findings. Be sure to cite your sources in-text and on a References page using APA format.

Paper For Above Instructions

In this case study, we examine the condition of A.M., a 21-year-old female diagnosed with Type I diabetes who has been experiencing severe gastrointestinal symptoms for three days. Her presentation indicates a potential development of diabetic ketoacidosis (DKA), a significant and life-threatening complication of diabetes often precipitated by infection, missed insulin doses, or poor oral intake (Kitabchi et al., 2009; Crespo et al., 2019).

A.M.’s symptoms of nausea, vomiting, diarrhea, fever, and a fruity odor upon breath strongly suggest DKA, as indicated by her inability to maintain her blood sugar levels due to her current illness. The fruity odor is particularly indicative of acetone, a byproduct of fat metabolism that occurs when insulin is insufficient (Umpierrez et al., 2014). Additionally, her high glucometer readings illustrate uncontrolled blood glucose, further supporting this hypothesis. She is also displaying classic signs of dehydration: warm, flushed skin, drowsiness, and unsteadiness related to electrolyte imbalance and fluid deficiency from vomiting and diarrhea (Ludwig & Kwan, 2013).

To improve A.M.'s condition, immediate interventions are required, starting with medical stabilization. The first step is to provide foundational care which includes intravenous (IV) fluid resuscitation to counteract dehydration and restore normal blood volume. Normal saline solutions would typically be utilized initially, transitioning to dextrose-containing fluids once her blood glucose levels reach safe values (Crespo et al., 2019). This fluid management should be closely monitored to correct electrolyte imbalances, particularly potassium, which often becomes depleted in DKA (Draznin et al., 2016).

A.M. should also receive insulin therapy to lower her blood glucose levels effectively. The standard approach is an intravenous bolus followed by a continuous infusion based on her blood sugar levels and clinical response (Umpierrez et al., 2014). Continuous monitoring of her vitals, electrolytes, and blood glucose is essential to prevent complications such as cerebral edema or cardiac arrhythmias from rapid shifts in electrolyte levels.

Pharmacological measures aside, supportive care must address A.M.'s underlying illness. If indicated, the healthcare team should assess for potential infections given her fever and subsequent illness onset. Laboratory tests should be run to evaluate for possible sources of infection such as urinary tract infection (UTI) or pneumonia, which can precipitate DKA (Atkinson et al., 2014).

Education and follow-up are equally crucial elements of her care plan. A.M. will need guidance on managing her diabetes during illness to avoid such dire situations in the future. Recommendations may include educating her on sick day management, emphasizing the importance of monitoring blood glucose levels and ketones, maintaining hydration, and knowing when to seek medical care (Ludwig & Kwan, 2013; Draznin et al., 2016).

In summary, A.M.'s presentation underscores the urgency of treating DKA in individuals with Type I diabetes who are experiencing concurrent illnesses. A combination of aggressive hydration, insulin therapy, and vigilant monitoring, alongside education focused on diabetes management during illness, will be fundamental in stabilizing her condition and preventing future occurrences.

References

  • Atkinson, M. A., Eisenbarth, G., & Michels, A. (2014). Type 1 diabetes. The Lancet, 383(9911), 69-82.

  • Crespo, F., Vázquez, J. I., & Rodríguez, M. M. (2019). Diabetic ketoacidosis: Clinical implications and treatment. Endocrinology and Metabolism Clinics, 48(2), 303-310.

  • Draznin, B., Aroda, V. R., & Bakris, G. (2016). Hyperglycemic crises in adult patients with diabetes. Diabetes Care, 39(Supplement 1), S118-S126.

  • Kitabchi, A. E., Umpierrez, G. E., & Miles, J. M. (2009). Hyperglycemic crises in adult patients with diabetes. Diabetes Care, 32(7), 1335-1343.

  • Ludwig, B., & Kwan, J. (2013). Sick-day management for adults with diabetes. BMJ, 347, f4587.

  • Umpierrez, G. E., Ferrannini, E., & deFronzo, R. A. (2014). Diabetic ketoacidosis and hyperglycemic hyperosmolar state: What’s the difference? Diabetes Care, 37(12), 3480-3486.