Mr Hassan is your diabetic patient , aged 45 years and suffer from diabetesSince 5 years , he ring you this morning because he feel severe epigastric Pain associated with repeated vomiting and Sweating.

Ask the patient 3 questions before you advice him

Remind me about your treatmentDo you have any other $ diarrhea, chest painMake random sugar and call me immediately

No diarrhea Random sugar is HHH

Case Study

Mr Hassan you have to be admitted to Hospital immediately, once their let the physician to call me

In the ER the physician , after a short history ,and checking vital signs recommend the Nurse to take the followings

Random SugarBp 90/60Pulse 100 regularTemp 37.5 CABG arterial sampleIv root and take an enough venous sampleUrine ECG

Work blood for

• Random sugar• Urine for sugar and acetone• Electrolytes• Renal function,hepatic function• CBC• Serial Troponin HS, cardiac enzymes• Urine and Bld culture• ECG• Chest radiology and US bed side

DD

• MI• DKA• Hypoglycemia• Ketosis (starvation, Alcoholic, Pregnancy)• Acute Abdomen • Gastroenteritis

• Others

Severity of the condition

• Po2, Pco2, O2 saturation

• pH

• Hco3

• Anion gap

• Osmolality

• State of consiousness

• PPT factor MI, infection, stroke

The following patient data

• Random Sugar 600mg%• Urine Sugar +++, acetone++• K 5.2mEqu/L• pH 7.3• Hco3 15• Anion gap 16• Osomolality 300• Creatinine 1.2• CBC leukocytes 12.000• Troponin +ve (2nd analysis)• ECG Non Q wave infarction

Diagnosis

• MI

• MI+DKA (stress)

• HHS

• Others

Admission in ICU,CCU

• Monitor

• Treatment of ppt condition

• Cardiology Consultation & intervetion

• Fluid ressusitation (MI, CVP)

• Electrolytes

• Insulin

Mr Hassan known to have IHD

• Intervention

• Fibrinolytic agent

• Heparinization

• Antiplatelets

• Hydration CVP

• O2

Expected complications

• Cardiac complications MI• Hypoglycemia• Prolonged DKA• Brain edema• Thromboembolic • Renal failure• ARD syndrome• Arrhythmias

Hyperglycemic crisesis it preventable

• yes

• How

• Patient health education

• Improvement diabetes care