Case Scenario No.

3 (DM, HTN)

Name: Dina Mateo

Age: 61 y.o
Status: Married
Occupation: retired teacher
Chief Complaint: weakness and drowsy
Doctor: Dr. Pilo (endocrinologist)
Diagnosis: Type 1 DM

A retired teacher Mrs. Mateo, 61 y/o was brought to ER by her daughter in a semi
conscious state after attending a party. She is a known case of IDDM, CHF and
HTN on treatment. “Kumain siya ng maraming cake tapos hindi pala siya nag
inject ng kanyang Insulin”, according to her daughter.
Blood sugar result shows High via glucometer. Evidence of fruity, sweet breath
and deep rapid breathing was noted.
Connected to Cardiac monitor and O2. Temp. = 97F, PR = 84 bpm, RR = 36
breaths/min, BP 140/90 mmHg, SPO2 98% with 2L/min O2 face mask.
Initial Lab results: ABG Bicarbonate level= 9 mEq/L, pH 6, UDS + Ketones, Na+ =
118 mEq/L, K+ = 6 mEq/L, BUN =29 mg/dL

 STAT Humulin R 10u SC to be followed with continous Insulin IV drip, dose

according to blood sugar result q hourly.( conc: Humulin R 24 units in 60 ml
NSS at 15 ml/hr (6 u/hr) via infusion pump till blood sugar below 180 mg/dL
then decrease rate at 7.5 ml/hr (3 u/hr).
 Blood sugar monitoring q hourly
 Urine dipstick q 2 hourly
 IVF regimen : NSS 2L for 2 hours, then NSS 1L for 2 hours, then 1L q 4 hours
 K+ replacement (KCl) 20 mEq/Lper liter of fluid till K+ is normal
 ABG + LFT + RFT q hourly
 Do ECG, Blood and Urine Culture
 NPO except meds ( anti HTN and CHF )look for HTN and CHF drugs eg.
amlodipine
 Monitor level of consciousness