28: Kayleigh

Kayleigh is 14 years old and has diabetes mellitus. She was diagnosed when she was 9 years old and her parents have actively encouraged Kayleigh to take responsibility for managing her blood glucose, diet and insulin regime. Kayleigh missed her last endocrine clinic appointment and has recently started drinking alcohol with her friends. Kayleigh has been brought to the Emergency Department today by her Dad, as she has been passing urine frequently, feels tired and lethargic, is complaining of abdominal pain, and has had a blood glucose above 15mmol/l for the last 24 hours. Dad has also reported smelling pear drops on Kayleigh’s breathe (ketones). Kayleigh’s presentation demonstrates diabetic ketoacidosis.

On examination, Kayleigh is:

A – Self ventilating in air with saturations >95%

B – Respiratory rate – 25 breaths per minute, deep breathing pattern.

C – Heart rate 120 beats per minute, ECG shows cardiac arrhythmia, blood pressure 110/70, capillary refill time 3 secs.

D – Lethargic and moody

E – Temperature 36.9°C

F – Reduced skin turgor, dry mucus membranes.

G – Blood glucose is 23mmol/l

  • Based on the information above, which electrolytes would you expect to be outside of the normal range?
  • Which electrolyte is known to cause cardiac arrhythmias when outside the normal range?
  • What is a normal blood glucose level?
  • How much fluid does Kayleigh require?

› Suggested answers

  • Based on the information above, which electrolytes would you expect to be outside of the normal range?

In diabetic ketoacidosis, bicarbonate, potassium, and glucose are frequently seen outside of their normal ranges, with a lower than normal bicarbonate and higher than normal potassium and glucose. Urea and creatinine will also be high.

  • Which electrolyte is known to cause cardiac arrhythmias when outside the normal range?
  •  
  • What is a normal blood glucose level?

Normal blood glucose ranges from 3.9mmol/l to 6.9mmol/l.

  • How much fluid does Kayleigh require?

460mls