Emergency Case Of A Type 1 Diabetic Male

A 32-year-old male with type 1 diabetes since age 14 years, was presented in the ED for drowsiness, fever, cough, diffuse abdominal pain, and vomiting. Fever and cough have started 2 days ago, and the patient could not drink or eat. His insulin regimen includes glargine 24 IU at bedtime and a rapid-acting insulin analog before each meal. Examination He is tachypneic, febrile (102.2°C), pulse rate 104bpm. respiratory rate 24breaths per minute, BP 100770mmHg.

He appears slightly confused. Dry mucous membranes, poor skin turgor, and rales in the right lower chest. Rapid hematology and biochemical tests showed hematocrit 48%, hemoglobin 14.3 g/dl (143 g/L), white blood cell count 18,000/ μ l, glucose 450 mg/dl (25.0 mmol/L), urea 60 mg/dl (10.2 mmol/L), creatinine 1.4 mg/dl (123.7 μ mol/L), Na+ 152 mEq/L, K+ 5.3 mEq/L, PO4 3−2.3 mEq/L (0.74 mmol/L), and Cl− 110 mmol/L. Arterial pH was 6.9,…