salam for every one in this website and Im studying clinical medicine in china,and we have siminar class for this case,I hope u'll help me to answer the last questions for this case thxxxxx
1-Medical history
33-year-old business man who hasn’t seen a doctor in years
Severe excruciating polydipsia(thirst), polyuria, weight loss for 2 days after consuming 10 liter of iced carbonated beverage
Nausea/vomiting, abdominal pain and shortness of breath for 5 hours, blurred vision, and gradual unconsciousness
Obese
Hypertension without any medication
Occasionally felt tired, but no polyuria, polydypsia, polyphagia or weight loss.
One uncle with T2DM
300 ml alcohol per week for 10 years
Smokes 1 pack per day
2-Physical examination
BP110/60 mmHg, P 98 beats/min,
R 18 breaths/min, T 36.0°C
Weight = 98 kg, BMI = 33.1 kg/m²
Dry skin and mucous membranes
Sunken eyes
Examination of the lungs, heart was normal.
No abdominal tenderness
Lethargy /obtundationWhat’s your impression?
For diagnosis, what more data you need?
3-Laboratory test
Glu: 161.9 mmol/L
Na+ 97.7 mmol/L
K+ 4.45 mmol/L
Cl- 68.3 mmol/L
Osmolality 377.3 mOsmol/l,
pH 7.26
Cr 222 µmol/L
Bun 11.1 mmol/l
Urine ketones +.
4-Serum Lipid
Total triglycerides (TG) : 8.74 mmol/L
Total cholesterol (TC): 8.39 mmol/l
high density lipoprotein-cholesterol (HDL-C) 0.89 mmol/l
low density lipoprotein-cholesterol (LDL-C) 3.65 mmol/l
5-Diagnosis????????????????
Diabetic Ketoacidosis
Hyperosmolar state
Hyposodiumia
Renal insufficiency
Dyslipdemia
What’s your first step of management????

6-Management of Diabetic Ketoacidosis
Confirm diagnosis (↑plasma glucose, positive serum ketones, metabolic acidosis).
Assess:  Serum electrolytes, Acid-base, Renal function
Replace fluids: 0.9% saline
Administer regular insulin: 0.1 units/kg per hour by continuous IV infusion
Replace K+
Monitor glucose, blood pressure, pulse
Continue above until patient is stable, glucose goal is 150–250 mg/dL, and acidosis is resolved.
Administer intermediate or long-acting insulin as soon as patient is eating.
What’s your Next step of management????
Diagnosis?
What’s your management plan?
First?
Next?

salam for every one in this website and Im studying clinical medicine in china,and we have siminar class for this case,I hope u'll help me to answer the last questions for this case thxxxxx
1-Medical history
33-year-old business man who hasn’t seen a doctor in years
Severe excruciating polydipsia(thirst), polyuria, weight loss for 2 days after consuming 10 liter of iced carbonated beverage
Nausea/vomiting, abdominal pain and shortness of breath for 5 hours, blurred vision, and gradual unconsciousness
Obese
Hypertension without any medication
Occasionally felt tired, but no polyuria, polydypsia, polyphagia or weight loss.
One uncle with T2DM
300 ml alcohol per week for 10 years
Smokes 1 pack per day
2-Physical examination
BP110/60 mmHg, P 98 beats/min,
R 18 breaths/min, T 36.0°C
Weight = 98 kg, BMI = 33.1 kg/m²
Dry skin and mucous membranes
Sunken eyes
Examination of the lungs, heart was normal.
No abdominal tenderness
Lethargy /obtundationWhat’s your impression?
For diagnosis, what more data you need?
3-Laboratory test
Glu: 161.9 mmol/L
Na+ 97.7 mmol/L
K+ 4.45 mmol/L
Cl- 68.3 mmol/L
Osmolality 377.3 mOsmol/l,
pH 7.26
Cr 222 µmol/L
Bun 11.1 mmol/l
Urine ketones +.
4-Serum Lipid
Total triglycerides (TG) : 8.74 mmol/L
Total cholesterol (TC): 8.39 mmol/l
high density lipoprotein-cholesterol (HDL-C) 0.89 mmol/l
low density lipoprotein-cholesterol (LDL-C) 3.65 mmol/l
5-Diagnosis????????????????
Diabetic Ketoacidosis
Hyperosmolar state
Hyposodiumia
Renal insufficiency
Dyslipdemia
What’s your first step of management????

6-Management of Diabetic Ketoacidosis
Confirm diagnosis (↑plasma glucose, positive serum ketones, metabolic acidosis).
Assess: Serum electrolytes, Acid-base, Renal function
Replace fluids: 0.9% saline
Administer regular insulin: 0.1 units/kg per hour by continuous IV infusion
Replace K+
Monitor glucose, blood pressure, pulse
Continue above until patient is stable, glucose goal is 150–250 mg/dL, and acidosis is resolved.
Administer intermediate or long-acting insulin as soon as patient is eating.
What’s your Next step of management????
Diagnosis?
What’s your management plan?
First?
Next?