Endocrine Case Histories - Case 28

A 21-year-old noncompliant male with a history of type I (insulin-dependent) diabetes mellitus was found in a coma. His blood glucose was high, as well as his urine glucose, urine ketones, and serum ketones. His serum bicarbonate was <12 mEq/L. His respiration was exaggerated and his breath had an acetone odor. His blood pressure was 90/60 and his pulse weak and rapid (120).

1. Define noncompliant.

2. Is this person experiencing ketoacidosis or insulin shock? Explain your answer.

3. Why is the serum bicarbonate low?

4. What is the acid-base status of this individual?

5. What is the cause of the dyspnea, hypotension, and tachycardia?

6. What type of treatment does this person need?

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