PBL 12 - PBL Type 1 DM PDF

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Summary

PBL Type 1 DM...

Description

PBL

Trigger -

16y/o boy T1DM Drowsy

Causes 1. -

Drowsy Hungry Hypoglycemia Hyperglycemia Anaemia Tumour in the head Cancer Infection (Meningitis) Drugs (Sleeping drugs) Physical activity Hypotension Heat stroke Head injury

History 1. -

Presenting illness Onset of drowsiness morning of admission Duration Unwell for past 1 week with fever Associated symptoms (fever, pain) fever, cough and vomiting several times over the last two days Relieving/Aggravating factors Pale Worsen in the morning

2. -

Drugs Allergy Current medication subcutaneous insulin injection Compliance not compliance Intake of vitamins or supplements or traditional medicine Intake of NSAIDs

3. Family - Siblings or parents having DM or other dz like CVD or having similar symptoms - Mother diabetic

4. -

Social Recent activity Alcohol or smoking Diet Sexual activity

5. -

Surgery or medical Hospitalised Brain surgery Trauma First diagnosed with T1DM 12y/o

Physical examination Inspection: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

Vital signs BP 95/60 mmHg HR 120bpm RR Temperature 38oc Pale Pain scale Shivering/tremor Conscious state Glasgow Coma Score of 10 with equally sluggish mid-size pupils Dehydration Skin turgor Glossitis Ketotic fetor – smell Kussmaul breathing with strong acetone breath Any enlargement or mass Thin Oxygen saturation 96% on room air

Palpation 1. Enlargement or mass 2. Lymph nodes

Percussion 1. Thyroid

Auscultation 1. Dual heart sounds

Lab Investigation 1. 2. 3. 4. 5. 6. 7. 8. 9.

FBC – White cells, Red cells for fever/infection increased white cell, neutrophils, eosinophils Electrolyte – Hypovolaemia (Potassium, Sodium) hyperkalaemia, hyponatraemia Urine test – glycosuria, ketone bodies 4+ glucose & 3+ ketones RFT increased urea, creatinine > renal impairment Random Blood Glucose 30 mmol/L; glucometer HI LFT – Cirrhosis increased ALT ABG – pH metabolic acidosis with respiratory compensation Serum osmolality increased Anion gap = (Sodium + Potassium) – (Chloride + Bicarbonate) = (130+5.2) – (95+8) = 32.3mmol/L ketone bodies

Diagnosis DKA – d/t infection, acidosis with 3+ ketone bodies

Management 1. 2. 3. 4.

Insulin subcutaneous Treat infection – C&S, antibiotics IV broad-spectrum antibiotics Saline – drink more water IV fluid Vital signs, urine output, fluid intake, alterations in biochemical profile – electrolytes, glucose, ABG

Term -

Drowsy: lethargy Kussmaul breathing: deep, sighing breaths in severe metabolic acidosis Clonus: muscular spasm with regular contraction

1. 2. 3. 4. 5. 6.

Glasgow Coma Scale Difference between Type 1 and Type 2 DM Causes of drowsiness Describe the anatomy and histology of pancreas Describe glucose homeostasis Acute complication of DM

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