question archive A Patient with Dysuria, Nausea and Abdominal Pain You are asked to see a 32-year-old female with Type I diabetes who presents to the Emergency Department complaining of abdominal pain and dysuria
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A Patient with Dysuria, Nausea and Abdominal Pain You are asked to see a 32-year-old female with Type I diabetes who presents to the Emergency Department complaining of abdominal pain and dysuria. The patient had been feeling well until two days prior to admission when she began to notice dysuria and urinary frequency. On the morning of admission she began to have nausea and abdominal pain, and because she was unable to eat she stopped taking her insulin. The abdominal pain became worse so she came to the hospital. The pain is in the epigastric region without radiation. She denies bloody diarrhea, fever, chills, sweats. She had not vomited yet but felt severe nausea. She states that she was too busy to check her finger sticks but that she had been strict with her diet. She is married, has one child; denies alcohol or tobacco use. She has no allergies. Meds: Glargine 28 u qhs, Aspart 4-10u TID AC. Physical exam - uncomfortable but in NAD. RR 26 labored. Supine: BP = 108/62, HR 116; upright BP 86/50, HR 138; Temp 99.8. SKIN: normal. HEENT - conjunctivae pink, anicteric, oropharynx/sinuses/TMs are clear; fundi benign. HEART - regular rhythm without murmurs or rub CHEST - clear Bs, (-) rales ABD - normoactive bowel sounds, mild midepigastric tenderness and flank tenderness, no organomegaly or masses. Rectal - no masses, nontender, hemoccult negative. Extremities: no edema. LABS Na 136, K 5.4, Cl 111, HCO3 8, glu 640, Cr 1.3 Hb 14.0, Hct 42.1, WBC 12.1, plts 420 K LFTs = wnl, Phosphate = 6.0, Ca++ = 8.9, Amylase = 300, Alb = 3.9 UA - specific gravity 1.022/+ ketones/ 20 WBC/2 RBC per HPF CXR - clear lung fields EKG - NSR; normal intervals, negative ST/T wave changes ABG (room air): 7.08/pCO2 20/pO2 107 Questions 1. What is most likely diagnosis? What urgent treatment is required?