Diabetic Ketoacidosis (DKA)
History of Present Problem:
Diana Humphries is a 45-year-old woman with chronic kidney disease stage III and diabetes mellitus type1 who checks
her blood sugar daily, or whenever she feels like it. She has been feeling increasingly nauseated the past 12 hours. She has
had a harsh, productive cough of yellow sputum the past three days. She checked her blood glucose before going to bed
last night and it was 382, but then she fell asleep early and missed her bedtime dose of glargine (Lantus) insulin. When
she awoke this morning, she had generalized abdominal pain and continued to feel nauseated and had a large emesis. Her
glucometer was unable to read her blood glucose because it was too high. She took 10 units of lispro (Humalog) insulin
this morning. Her nausea has increased all morning and she has been unable to eat or keep anything down despite having
an increased thirst and appetite. She also has had increased frequency of urination. When her lunchtime glucometer gave
no reading because it was too high and out of range, she called 9-1-1 to be evaluated in the emergency department (ED).
,Diabetic Ketoacidosis (DKA)
Diana Humphries, 45 years old
Primary Concept
Fluid and Electrolyte Balance
Interrelated Concepts (In order of emphasis)
, 1. Acid-Base Balance
2. Glucose Regulation
3. Infection
4. Pain
5. Clinical Judgment
6. Patient Education
7. Communication
8. Collaboration
History of Present Problem:
Diana Humphries is a 45-year-old woman with chronic kidney disease stage III and diabetes mellitus type1 who checks
her blood sugar daily, or whenever she feels like it. She has been feeling increasingly nauseated the past 12 hours. She has
had a harsh, productive cough of yellow sputum the past three days. She checked her blood glucose before going to bed
last night and it was 382, but then she fell asleep early and missed her bedtime dose of glargine (Lantus) insulin. When
she awoke this morning, she had generalized abdominal pain and continued to feel nauseated and had a large emesis. Her
glucometer was unable to read her blood glucose because it was too high. She took 10 units of lispro (Humalog) insulin
this morning. Her nausea has increased all morning and she has been unable to eat or keep anything down despite having
an increased thirst and appetite. She also has had increased frequency of urination. When her lunchtime glucometer gave
no reading because it was too high and out of range, she called 9-1-1 to be evaluated in the emergency department (ED).
,Diabetic Ketoacidosis (DKA)
Diana Humphries, 45 years old
Primary Concept
Fluid and Electrolyte Balance
Interrelated Concepts (In order of emphasis)
, 1. Acid-Base Balance
2. Glucose Regulation
3. Infection
4. Pain
5. Clinical Judgment
6. Patient Education
7. Communication
8. Collaboration
