A 67-year-old patient is admitted with an altered mental state. There is a history of type 2 diabetes on oral agents
Parameter |
Patient Value |
Adult Normal Range |
pH |
7.42 |
7.35 – 7.45 |
pO2 |
60 mmHg (7.9 kPa) |
|
pCO2 |
37 mmHg (4.9 kPa) |
35 – 45 (4.7 – 6.0) |
Standard bicarbonate |
24 mmol/L |
22 – 29 |
Base excess |
0 mmol/L |
-3 to +3 |
Blood haemoglobin |
178 g/L* |
115 – 155 |
Haematocrit |
0.54* |
0.35 – 0.46 |
Sodium |
136 mmol/L |
135 – 145 |
Potassium |
3.7 mmol/L |
3.5 – 5.2 |
Ionised Calcium |
1.06 mmol/L* |
1.15 – 1.30 |
Chloride |
95 mmol/L |
95 – 110 |
Glucose |
47 mmol/L* |
4.0 – 8.0 |
Lactate |
5.9 mmol/L* |
0.5 – 1.3 |
Urea |
22 mmol/L* |
3.0 – 8.0 |
Creatinine |
209 µmol/L* |
45 – 90 |
a) List the important biochemical abnormalities, showing your calculations where appropriate. (10% marks)
b) List the diagnosis most consistent with these abnormalities. (5% marks)
c) List three complications of this condition. (15% marks)
Not available.
a)
The biochemical abnormalities, important and unimportant, are:
Sodium (corrected) = Sodium (measured) + glucose / 4
= 136 + (47/4)
= 136+ 11.75
= 148, or so
b)
This is HHS, an obvious spot diagnosis which was rewarded with the absolute minimum of marks.
c)
To pick three complications would be hard, as this condition has a million possible complications:
Hyperglycemic Comas by P. VERNON VAN HEERDEN from Vincent, Jean-Louis, et al. Textbook of Critical Care: Expert Consult Premium. Elsevier Health Sciences, 2011.
Rosenbloom, Arlan L. "Intracerebral crises during treatment of diabetic ketoacidosis." Diabetes care 13.1 (1990): 22-33.
Hegazi, Mohamed Osama, and Anant Mashankar. "Central pontine myelinolysis in the hyperosmolar hyperglycaemic state." Medical Principles and Practice 22.1 (2013): 96-99.
Kitabchi, Abbas E., et al. "Hyperglycemic crises in adult patients with diabetes." Diabetes care 32.7 (2009): 1335-1343.