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A 19 year old female presents to the emergency department wi…

A 19 year old female presents to the emergency department with complaints from her best friend of “she isn’t acting her normal self”. The patient is lethargic though awakens to voice, tachypneic, diaphoretic, with poor skin turgor. Her best friend reports she hasn’t felt good for two days, but has progressively worsened. The patient denies any medical problems, smoking, or drug use. She reports she is not currently sexually active.  She complains of extreme thirst and fatigue.  Labs: WBC 20K, H&H 17.5 & 45, Plt 450K. Na+ 129, K+ 5.6, anion gap 25, Cr 1.8, BUN 40, Ca+ 8.5, glucose 448. Serum acetone moderate.  ABG: pH 7.12, CO2 22, O2 80, HCO3 8.  Vitals: Temp 97.8F, Pulse 122, BP 104/54, RR 34, O2 96% on room air.  What is the patient’s primary diagnosis? 

You are putting in admission orders on a patient diagnosed w…

You are putting in admission orders on a patient diagnosed with a COPD exacerbation. The patient also has a history of hypertension and type II diabetes. She normally only take metformin 500mg PO BID for her diabetes. You understand the solu-medrol given for the exacerbation will likely cause hyperglycemia; therefore, you order sliding scale Humulin R to be given before meals.  If this patient received Humulin R insulin at 11am, what time will its effect likely have peaked? 

You are putting in admission orders on a patient diagnosed w…

You are putting in admission orders on a patient diagnosed with a COPD exacerbation. The patient also has a history of hypertension and type II diabetes. She normally only take metformin 500mg PO BID for her diabetes. You understand the solu-medrol given for the exacerbation will likely cause hyperglycemia; therefore, you order sliding scale Humulin R to be given before meals.  If this patient received Humulin R insulin at 11am, what time will its effect have peaked?