Question

Steve Burr 38 has type 1 diabetes. He hasn't been feeling well for the last three days and hasn't eaten or injected his insulin. He's confused and lethargic. His respiratory rate is 32 breaths/minute, and his breath has a fruity odor. His serum glucose level is 620 mg/dl. While receiving 40% o2, his lab values are:

• pH 7.15
• Paco2 30 mm Hg
• Pao2 130 mm Hg
• HCO3 10 mg Hg
• SaO2: 94%

What is your assessment?

Answer 1

The patient have fruity smell breath, high blood glucose levels ,variation in breathing patterns and abnormal ABG analysis show that the presence of metabolic acidosis ( diabetic keto acidosis or DKA). In this condition the insulin is lack in the body and fats are breakdown for energy and byproducts are ketone. Excess amount of ketone in the body cause diabetic keto acidosis.

From the result of ABG analysis the pH value is less than normal, PCO2 is less than normal and HCO3 level also Less than normal.

pH level and HCO3 level indicate increase acid level in the body and PCO2 level indicate that the respiratory function try to compensate this acidosis but this is partial compensation because the pH remain low.