Case
iHuman week8 plan iHuman case :Melissa stewart pediatrics (DKA)
CC – Confusion – reported by patient’s mother.
Diagnosis – DKA
– DKA, substance use disorder, diabetes insipidus, dehydration, DM Type 1
Tests- BMP, UA, Drug tox, arterial blood gas, 12lead ECG, beta-hydroxybutyric acid (BOH)
Problem Statement:
( Demographic description – chief complaint – Hx and PE key findings – risk factors )
Melissa Stewart is a 12 year old child brought in by her mother with complaint of confusion since
morning. Melissa is obtunded and only responsive to verbal commands. Her mother states that she
recently has been losing weight and eating more and experiencing polyuria and polydipsia as well as
blurred vision. Today she is tachypneic, tachycardia, lethargic and confused with continued blurry vision.
PE shows decreased skin tugor, delayed capillary refill and fruity breath. Risk factors include a family
history of a “sugar problem”.
CC: Melissa Stewart is a 12 year old child brought in by her mother with complaint of confusion since
morning..
HPI: . Melissa is obtunded and only responsive to verbal commands. Her mother states that she recently
has been losing weight and eating more and experiencing polyuria and polydipsia as well as blurred
vision. Today she is tachypneic, tachycardia, lethargic and confused with continued blurry vision.
Meds: None
PMH: noncontributory
FH: Paternal grandfather diabetes.
SH: Mother states child does not smoke, drink alcohol, or take recreational drugs.
ROS: Only positive findings are seen in HPI
Physical Exam:
VS: Pulse – 85; BP – 88/56 RR – 20; T – 98.6F; SpO2 – 99%
Skin: Shows decreased skin tugor
Cardiovascular: Delayed capillary refill seen in fingers +3 seconds, and toes +3 seconds.
