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Endocrine Pancreas
Review of Symptoms and Lab Results
The reported nausea, vomiting, and abdominal pain may indicate a GI disorder, but combined with the patient's diabetes, unusual thirst, constant urination, and fatigue, the symptoms are more indicative of an endocrine disorder (Lippincott Williams & Wilkins, 2006).
Some of the patient's lab results fall into the normal range: BUN of 16 mg/dl (normal is 8 -- 25 mg/dl); creatinine of 1.3 (normal is 0.5 -- 1.7 mg/dl); sodium of 139 mEq/L (normal is 135 -- 145 mEq/L); blood pressure of 90/60 (normal is less than 120/80); and temperature of 99 .1°F (Chernecky & Berger, 2001; Pagana & Pagana, 2003).
Other lab results fall outside of the normal range: glucose of 420 mg/dl is very high (normal is 60 to 110 mg/dl); 4+ glucose and 3+ ketones are very high (normal is no glucose or ketones present in the urine); pH of 7.12 is low (normal is 7.35 -- 7.45); PCO2 of 17 mmHg is low (normal is 35 -- 45 mmHg); chloride of 112 mEq/L is high (normal is 98 -- 106 mEq/L); bicarbonate of 5.6 mEq/L is low (normal is over 18); pulse of 136 is high...
Previously, diabetic ketacidosis (DKA) was considered primarily a complication of type 1 diabetes, but since the late 1990s, DKA has increasingly been found to be a complication of type 2 diabetes, particularly among obese African-Americans (Kitabchi, et al., 2009; Wolfson, et al., 2009).
Typical symptoms of DKA include polyuria (excessive urination), polydipsia (excessive thirst), vomiting, nausea, abdominal pain, weight loss, weakness, and blurred vision (Wolfson, et al., 2009). The patient reports six of these eight symptoms.
Justification of Diagnosis
The diagnostic criteria for DKA are arterial pH less than 7.30, serum bicarbonate less than 18 mEq/l, plasma…
References
Chernecky, C.C., & Berger, B.J. (Eds.). (2001). Laboratory tests and diagnostic procedures. Philadelphia: Saunders.
Haber, M.H., & Ward, P.C.J. (2002). Urine. In K. McClatchey (Ed.), Clinical laboratory medicine. Philadelphia: Lippincott Williams & Wilkins.
Kitabchi, A.E., Umpierrez, G.E., Miles, J.M., & Fisher, J.N. (2009). Hyperglycemic crises in adult patients with diabetes. Diabetes Care, 32(7): 1335 -- 1343. doi: 10.2337/dc09-9032.
Lee-Lewandrowski, E., Burnett, R.W., & Lewandrowski, K. (2002). Electrolytes and acid-base balance. In K. McClatchey (Ed.), Clinical laboratory medicine. Philadelphia: Lippincott Williams & Wilkins.
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