A year previously the creatinine level of the patient was taken and was safely in the normal range as shown in figure 6. After admission a EP was ordered and the results for creatinine were high for the patient as an individual despite being in the normal range which showed that AKI stage one was occurring which required immediate attention. Then the creatinine then entered in a sharp decline as the patient was on an IV drip and not eating or drinking. Also there was lots of excretion due to the DKA. In two GP appointments after treatment the creatinine was at the patient’s average again.
Diagnosis and discussion
DKA usually is diagnosed by a laboratory glucose that is greater than 11 mmol/L, a blood gas with a pH below 7.3, bicarbonate lower than 20 mmol/L and a positive result for ketones in the urine. In figure 1 it shows the patient’s blood glucose is 55.3 mol/L, the pH is …show more content…
This confirms that the patient is suffering from DKA and needs to be treated urgently according to the DKA protocol. The high CRP suggests an infection is present in the patient and this will need to be treated. This infection is probably the cause of the change in insulin requirements which brought on the DKA episode. Also an EP was ordered along with an urgent potassium and a venous blood gas to check the level of metabolic acidosis. The sodium is only slightly low so there is some hyponatremia present and definite severe metabolic acidosis due to the low pH and base excess. The lactate is very high which can happen when a diabetic patient takes metformin and it will need to be investigated to prevent lactic acidosis also occurring. An ECG can also be completed to check for any abnormalities related to the hypokalaemia. While the potassium seems normal from a second repeat sample sent after the haemolysed sample
Diagnosis and discussion
DKA usually is diagnosed by a laboratory glucose that is greater than 11 mmol/L, a blood gas with a pH below 7.3, bicarbonate lower than 20 mmol/L and a positive result for ketones in the urine. In figure 1 it shows the patient’s blood glucose is 55.3 mol/L, the pH is …show more content…
This confirms that the patient is suffering from DKA and needs to be treated urgently according to the DKA protocol. The high CRP suggests an infection is present in the patient and this will need to be treated. This infection is probably the cause of the change in insulin requirements which brought on the DKA episode. Also an EP was ordered along with an urgent potassium and a venous blood gas to check the level of metabolic acidosis. The sodium is only slightly low so there is some hyponatremia present and definite severe metabolic acidosis due to the low pH and base excess. The lactate is very high which can happen when a diabetic patient takes metformin and it will need to be investigated to prevent lactic acidosis also occurring. An ECG can also be completed to check for any abnormalities related to the hypokalaemia. While the potassium seems normal from a second repeat sample sent after the haemolysed sample