Case 6

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

  • Sloth,
  • Ignorance,
  • Fixation