Case 6. Polyuria (Diabetes mellitus)
Author: Uliana Marusyk
Case outline
You are a resident doctor of the therapeutic department.
Your new patient is Maria, 35 years old.
She complained about repeated vomiting, suffering, severe headache, a
feeling of compression and throbbing in the temples, tingling in the
ears, laxity and weakness, partial urination.
According to anamnesis periodic headache of varying intensity
disturbs about six months. With the words of the patient her mother is
observed in a family doctor about hypertension.
Objectively: the skin is clean, slightly pale and dry to the touch.
Turgor and tissue elasticity are moderately reduced. The tongue is
covered with white layers. The percurious limits of the heart are not
altered, auscultatively rhythmic tones, tachycardia is observed. The
pulse on the radial artery is stable, with a high filling, 92 beats per
minute. Respiratory rate 22 per minute. Percussion over the lungs, clear
pulmonary sound, auscultative vezicular breathing is evenly performed
on both sides, wheezing is absent. Abdomen is soft, nebolichny with
palpation. AT 140/100 mm Hg. Axial body temperature 37.2˚С. The height
of Mary is 172 cm, weight - 102 kg, BMI 39.8.
Choice 1. Hospitalize a patient in a therapeutic department / Give captopril and recommend contact wiyh family doctor / Urgent ECG
The patient is delivered to the therapeutic department, receiving
furacemide at a dose of 40 mg once. The pulse on the radius artery is
steady, with normal filling, 84 beats per minute. Respiratory rate 22
per minute. Abdomen is soft, nebolichny with palpation. AT 120/80 mm
Hg., slight edema on the legs, specific odor of the mouth.
Choice 2. ECG, common blood test, urin alysis,
ultrasound examination of the heart / ECG, common blood test,
cardiologist’s consultation / ECG, common blood test, urine test,
cardiologist consultation, ultrasound examination of the heart
Common blood test without pathological changes, in the urine analysis
revealed acetone - +++, ultrasound of the heart - pathological changes
weren’t detected.
Choice 3. Assign the patient to ceftriaxone in a
dose of 1.0 g twice a day i/m / IT glucose-salt solution in a ratio of
2: 1 / biochemical blood test
The results of biochemical analysis of blood were obtained, hyperglycemia was detected.
Choice 4. Glucose-test / consultation of an endocrinologist / consultation of a nephrologist
Learning Objectives
- Differential diagnosis of the syndrome of hyperglycemia
- Leading clinical symptoms and syndromes in diabetes
- Differential diagnosis of acute and chronic complications of diabetes
- Leading clinical symptoms and syndromes in coma: ketoatsydotychna hyperglycemic, hypoglycemic
- Providing emergency assistance in a coma
- Diagnosis and tactics of patients with chronic complications of diabetes
Errors covered
