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Mrs Ballesteros, age 78, is hospitalized in the intensive care unit(ICU), with complications of type 1 DM.

Most recently, she is experiencing diabetic ketoacidosis with a blood glucose of 320mg/dl. In addition, she has coronary heart diseas(CHD) from the microvascular complications of her diabetes, she has a pulmonary artery catheter to monitor his hemodynamic status. Her primary clinical manifestation from CHD are hypertension, tachycardia, and occasional arrhythmias. At present her level of consciousness(LOC) is impaied, she is breathing with kussmaul respirations, her breath is acetone in nature, and she is extremely fatigue.

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