polydipsia, diplopia, cephalgia, appendectomy, UTIs, tachycardia, glycosuria, glucometer, hyperglycemia

Ellen James, a 25 year old female patient came into the ER barely conscious. Patient complains of excessive emesis, polyuria, polydipsia, diplopia, cephalgiaand fatigue for the past two days. The emergency room M.D. (Dr. Gupta) suspects ketoacidosis. Patient also complains of rapid weight loss of 15 pounds in the past month, despite eating voraciously. The patient has not had past medical history showing a diagnosis of any chronic diseases. She does indicate a history of migraines, depression, and frequent UTIs. Past surgeries include an appendectomy in March 1998 and a tonsillectomy in 1985. There have been no recent hospitalizations on record. Physical examination reveals a BP of 145/80, WT of 115 lbs., HT of 5’6”, HR of 112 BPM (slight tachycardia), T of 99 degrees. Medications include Topamax 50mg for migraines and Cymbalta 200mg for depression, fish oil supplementation for health maintenance, daily vitamin, and powdered cranberry to treat recurrent UTI infection. Physician ordered a pregnancy test, CBC, and a urinalysis with checks for glycosuria, ketones, creatinine, microalbumin, and electrolytes. A vial of blood was sent for analysis of BG due to the inability of the glucometer to give a clear reading and displaying “High”. The blood will be tested for insulin and C-Peptide, to determine if the pancreas is still producing insulin or displaying insulin resistance. Patient was started on normal saline solution through an IV and given 10 units of insulin by IV to address hyperglycemia. Blood is also to be tested for WBCs to determine if antibiotics need to be prescribed.