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Diabetes Mellitus Case Assignment

A 49-year-old woman with 9-year history of diabetes mellitus admitted to the hospital. The patient is treated with basal-bolus insulin therapy in daily dose 48 Units. She has often episodes of ketoacidosis and hypoglycemia. The patient worked for a long time in the garden, after that she felt trembling in her hands, sweating and palpitations. She suddenly lost consciousness.

  • Physical examination: consciousness is absent. The skin is pale and moist. Single muscle cramps, masticatory trismus present. Breathing is not impaired. Respiratory rate 20 per minute.
  • Heart: rhythm is regular, muffled sounds, BP 138/90 mmHg, heart rate 100 per minute. Clear tongue. Abdomen is soft.
  • Using a catheter 150 ml of urine was received. Laboratory tests: plasma glucose – 1,8 mmol/l, urine acetone is negative. ECG: sinus tachycardia.
  1. Identify Syndromes.
  2. Preliminary diagnosis.
  3. Differential diagnosis.
  4. Additional examination plan with priority measures.
  5. Prescribe treatment

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