I put together these medical challenges. The cases are hypothetical and do not necessarily represent actual or typical presentations of medical diseases. Disclaimer is at the bottom of this page.
Thursday, April 18, 2013
Honk If You Like Electrolytes
A middle aged man is found down by EMS with a GCS 5. His neighbor reports that the patient was "feeling sick for several days and hadn't been seen." He is intubated in the emergency department for protection of his airway. Exam shows decreased skin turgor and dry oral mucosa. ABG shows pH 7.32, PaCO2 43mmHg, PaO2 240mmHg. A chemistry panel shows sodium 130, potassium 5, chloride 100, bicarbonate 19, BUN 40, Cr 1.4, and a serum glucose >1000mg/dL. CBC shows WBC 18, Hct 48, Plts 200. Urine dipstick is positive for leukocyte esterase and nitrites, negative for everything else. Urine culture grows out gram negative rods.
Challenge: What's the diagnosis?
Image of insulin in the public domain, from Wikipedia.
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