iHuman Pediatrics Case Study - Melissa Stewart - 12yrs Old Child CC: Confusion

Melissa Stewart – Pediatrics

CC – Confusion – reported by patient’s mother.

Diagnosis – DKA

 – DKA, substance use disorder, diabetes insipidus, dehydration, DM Type 1

Tests- BMP, UA, Drug tox, arterial blood gas, 12lead ECG, beta-hydroxybutyric acid (BOH)

Problem Statement:

( Demographic description – chief complaint – Hx and PE key findings – risk factors )

Melissa Stewart is a 12 year old child brought in by her mother with complaint of confusion since

morning. Melissa is obtunded and only responsive to verbal commands. Her mother states that she

recently has been losing weight and eating more and experiencing polyuria and polydipsia as well as

blurred vision. Today she is tachypneic, tachycardia, lethargic and confused with continued blurry vision.

PE shows decreased skin tugor, delayed capillary refill and fruity breath. Risk factors include a family

history of a “sugar problem”.

CC: Melissa Stewart is a 12 year old child brought in by her mother with complaint of confusion since

morning..

HPI: . Melissa is obtunded and only responsive to verbal commands. Her mother states that she recently

has been losing weight and eating more and experiencing polyuria and polydipsia as well as blurred

vision. Today she is tachypneic, tachycardia, lethargic and confused with continued blurry vision.

Meds: None

PMH: noncontributory

FH: Paternal grandfather diabetes.

SH: Mother states child does not smoke, drink alcohol, or take recreational drugs.

ROS: Only positive findings are seen in HPI

Physical Exam:

VS: Pulse – 85; BP – 88/56 RR – 20; T – 98.6F; SpO2 – 99%

Skin: Shows decreased skin tugor

Cardiovascular: Delayed capillary refill seen in fingers +3 seconds, and toes +3 seconds.

HEENT: breath smells fruity.

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ASSESSMENT/PLAN

Test Results:

 BMP: Hyponatremia, Hyperkalemia, Hyperglycemia (574), Elevated BUN/Cr, Metabolic acidosis

w/ elevated anion gap.

 UA: glycosuria, ketonuria w/ high osmolarity (no evidence of UTI)

 Drug Toxicology: Negative.

 Arterial Blood Gas: Partially compensated metabolic acidosis.

 Beta-hydroxybutyric acid: Elevated – indicating insulin deficiency

 12 lead ECG: Sinus tachycardia

Management Plan

 IV access

 Fluid resuscitation

 Electrolyte replacement (Potassium)

 Insulin Therapy

 IV Bicarbonate

 Once stable – consult parents on DM 1

Questions

1. Metabolic acidosis

2. Decreased Bicarbonate

3. Decreased intravascular volume

4. Increased lipolysis

5. Metabolic acidosis

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This study source was downloaded by 100000824387179 from qwivy.com on 04-24-2021 16:19:15 GMT -05:00

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This study source was downloaded by 100000824387179 from qwivy.com on 04-24-2021 16:19:15 GMT -05:00

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This study resource was

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This study source was downloaded by 100000824387179 from qwivy.com on 04-24-2021 16:19:15 GMT -05:00

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