Dka In Pregnancy Ppt

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Exam Shows Diffuse Abdominal Tenderness With Guarding.

A 14 y/o female is brought to the emergency department by her mother after being found unresponsive at home. She had been ill the day before with nausea and vomiting, but was not running a fever. Her parents had kept her home from school that day. When her mother came home at lunchtime to check on her, she was very lethargic and not responding coherently. By the time she arrived at the hospital, she had to be brought in to the ED on a gurney. Initial evaluation showed O2 sat 100% on room air, pulse 126, respirations 30, BP 92/68, temperature 101.2 F. She appears pale, mucous membranes are dry and she only responds to painful stimuli. Exam shows diffuse abdominal tenderness with guarding. Differential diagnosis? What initial treatment would you suggest? What labs would you order? Any xrays or additional studies? CBC WBC 23,500 Hgb 14.2 g/dL Hct 45% Platelets 425,000 BMP Sodium 126 Potassium 5.2 Chloride 87 CO2 <5 BUN 32 Creatinine 1.5 Glucose 1,376 Arterial Blood Gases pH 7.19 Po2 100 mm Hg HCO3 7.5 mmo/L Pco2 20 mm Hg Sao2 98% (room air) Urine Specific gravity 1.015 Ketones 4+ Leukocytes few Glucose 4+ Nitrates 0 RBCs many Diabetic ketoacidosis (DKA) is an acute metabolic complicat Continue reading >>

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Popular Questions

  1. dolby

    WalMart's ReliOn Ultima Reliable?

    I bought WalMart's ReliOn Ultima BG monitor since their strips are among the cheapest. (I have a prescription for Freestyle Lite, but can't get enough strips to test as much as I want.)
    They're both manufactured by Abbott Labs, but ReliOn's lancet device is big and unwieldy. If you're trying to draw blood from either hand, you should be able to hold and fire with one hand. It also slips away sometimes because it's circular (not rectangular).
    The strips are all individually packaged. So in order not to kill any time, you have to remove the strips from the package, then insert them half way to the monitor, then stab your finger, then draw blood, ensure you have enough blood or milk to get some more. Too many steps are involved here. If you stab and then try to remove the strip from the package, you risk having your blood smudged. It's too easy to botch the process and waste strips.
    I've graduated to using Freestyle Lite's lancet device with ReliOn. The strips, however, require more blood than Freestyle's simple black & white strips. You can actually see the blood travelling through the strip to its destination. However, the distance is too long and this often requires milking and oozing blood from the prick. When not enough blood comes out, you have to stab yourself elsewhere. I noticed that if you botch a stab and have to draw blood from another location, the reading frequently will be faulty and unusally low (like 34, 41, 57).
    One other thing: the numbers sometimes seem wildly off. I don't have Freestyle's strips to confirm these numbers. But do people find ReliOn to be Reliable? Dr. Bernstein's office only recommends Accucheck's Aviva. Do people find Aviva to be more accurate than Freestyle Lite or Relion Ultima?

  2. drewgolden

    Originally Posted by dolby
    One other thing: the numbers sometimes seem wildly off. I don't have Freestyle's strips to confirm these numbers. But do people find ReliOn to be Reliable? Dr. Bernstein's office only recommends Accucheck's Aviva. Do people find Aviva to be more accurate than Freestyle Lite or Relion Ultima? Yes, I have found the Relion Ultima to be VERY accurate. It is Abbot's BEST meter technology - and if you live in the UK you get the same great meter with 1/2 the blood required.
    The Freestyle Lite is my personal favorite - only because of the night light / test stip run way light - and code free strips. The Ultima requires coding - sticking the wand in with each pack of strips. And I did not like all of the waste the foil wrappers creates.
    -but- The ultima is more consistent than the Freestyle lite - shocking.
    I have tested all of the Accucheck meters and have found them to have the widest variability in testing. Plus the LARGEST test strips. I know there are a lot of people in the UK in love with it - it's just not got my heart.

  3. HarleyGuy

    I think the Multiclix(Accuchek) lancet device is the best for me. Really painless for the most part. You can buy it for $20 or so, but I just contacted Roche and asked for one and they gladly sent one. Of course, they now have given me one and I will have to buy the drum of lancets to use it. Smart move on their part.

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