Summary 2

Mrs N, a 42-year-old Malay lady, with diabetes mellitus for 6 years on S/C Mixtard 20units BD and dyslipidemia, has been ill for the past 3 months with palpitations, lethargy, numbness of hands and feet, presents with generalized body weakness for 3 days and shortness of breath for 1 day. It is associated with dizziness, and symptoms of uncontrolled diabetes and frothy urine. She has not been compliant to her follow-ups, medications or lifestyle modifications.

Question: Why do these "symptoms of uncontrolled diabetes" occur?

On examination, she was alert but ill looking. Her respiratory rate was 28 breaths/min and pulse rate was 102bpm. She was normotensive and afebrile. She has conjunctival pallor. Cardiovascular, respiratory and abdominal examinations were unremarkable. Sensory examination revealed reduced sensation (soft and pin prick) of hands and feet with loss of proprioception and reduced ankle jerk reflex.

Question: What do the sensory examination findings indicate?

Investigations revealed high random blood glucose (37.7mmol/l), ketonuria (3.9mmol/l) and severe metabolic acidosis (pH: 7.111, pCO2: 7.7mmHg, HCO3-: 2.4mmol/l, anion gap: 20.4 mmol/l) confirming the diagnosis of diabetic ketoacidosis.

Question: Why is the PCO2 value so low? What additional information does the anion gap indicate?

She also had mild hypochromic microcytic anemia (Hb: 10g/dL, MCV: 66.6fL MCH: 17.9pg) and proteinuria of 0.3g/dL. ECG, cholesterol profile, serum urea, creatinine and potassium were normal. However she had hyponatremia (126mmol/L) and hypoalbuminemia (22 g/L) with normal transaminase levels. Iron study was not done.

Question: What is a likely reason for her hyponatremia? Does the normal serum potassium mean that she has no potassium deficiency?

Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-ShareAlike 3.0 License