A 23-year-old male with a history of type I diabetes presented to the emergency department due to a change in mental status.   Nurses’ Notes   1200 23-year-old male with a history of diabetes type I brought to the emergency department by spouse for changes in mental status from his baseline. The client’s wife reports that he woke at 0600 to complete his morning routine. At approximately 1100 he became unaware of his surroundings and began sweating profusely and slurring his words. Breath sounds are clear but noted with a fruity citrus odor and deep rapid respiration’s. Sinus tachycardia per cardiac monitor. He is awake and alert, pupils equal and reactive to light. Vital Signs   Time 1200   Temp 99.5° F (37.5 °C)   P 118   RR 32   B/P 89/52   Pulse oximeter 89% on RA   Medications   Humalog insulin subcut sliding scale with meals   Lantus 10units QHS                 Which 4 findings are most significant?  

A patient taking IV levothyroxine starts to complain of feeling hot and chest pain. On assessment, you find that the heart rate is 125 bpm and blood pressure is 200/103. You immediately notify the physician of the patient’s condition and receive orders for lab work. Based on the patient’s signs and symptoms, what is the MOST important lab result at this time to determine the cause of the patient’s symptoms?

A 23-year-old male with a history of type I diabetes presented to the emergency department due to a change in mental status. Nurses’ Notes   1200. 23-year-old male with a history of diabetes type I brought to the emergency department by spouse for changes in mental status from his baseline. The client’s wife reports that he woke at 0600 to complete his morning routine. At approximately 1100 he became unaware of his surroundings and began sweating profusely and slurring his words. Breath sounds are clear but noted with a fruity citrus odor and deep rapid respiration’s. Sinus tachycardia per cardiac monitor. He is awake and alert, pupils equal and reactive to light. Weight 205lbs (93kg)   1215. Voided 30mL dark amber urine sent for urinalysis. Comprehensive metabolic panel, CBC, and ABG. IV of normal saline started. Capillary glucose is 440.   Vital Signs   Time 1200 1215   Temp 99.5° F (37.5 °C) 99.5° F (37.5 °C)   P 118 115   RR 32 30   B/P 89/52 92/56   Pulse oximeter 89% on RA 92% on 2L NC   Medications   Humalog insulin sliding scale with meals   Lantus 10unit QHS       Laboratory Report   Lab Results Reference range ABG pH 7.20 7.35-7.45 ABG PC02 45 35-45 mmHg ABG HC03 32 22-26 mEq/L Anion Gap  26

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