Case Questions:

  1. How would you differentiate clinically (by history and bedside exam) among diabetic ketoacidosis, hyperosmolar coma, alcoholic and lactic acidosis. How would you use glucose, B-OH butyric acid levels, and H measurements to differentiate among them?
  2. What are the biochemical consequences of failure to take insulin? How should insulin treatment for DKA be initiated? When should the insulin drip be D/C and what other type of insulin regimen be initiated?
  3. What is the significance of proteinuria in diabetes?
  4. What diagnosis does hypothermia in a diabetic patient suggest?
  5. This patient was treated with intravenous fluids, insulin, sodium bicarbonate and potassium chloride. These measures rapidly corrected his biochemical abnormalities but he remained comatose. What are the possible explanations for this outcome in the treatment of diabetic acidosis?
  6. Why would this patient be at higher risk for a coronary event at his young age?
  7. How is the dose of insulin decided on for perioperative management of the diabetic patient? Discuss management of the diabetic admitted in poor control and unable to eat.
  8. What complications of diabetes mellitus should be considered in the post op management of this patient?
  9. What could explain the patient's headaches and nightmares after discharge? What should be done to confirm your suspicion? What could be done to correct this problem?