A 38 year old diabetic woman with vomiting and abdominal pain

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For Case discussion : http://www.medicases.com/2011/10/i-was-quite-sick-oh-goodness.html

Present Illness




A 38-year-old art director for television documentary programmes with a 20 year history of well controlled diabetes presented to accident and emergency with a 24 hour history of abdominal pain and vomiting, which had become uncontrollable overnight. She said that she had felt well until 24 hours previously, and despite being unable to eat or keep any kind of fluid down, said that she had continued to take her normal amount of insulin.

Initial Data




BM stix glucose is 32 mmol/l. Lab results are pending.

System Review

Further elements of the history were collected as the patient was being assessed and treatment initiated. She feels very thirsty, but is not aware of passing much more urine than usual over the past 24 hours. Nothing else of note emerged. She has not been in contact with anyone who has been ill, and not eaten anything unusual or suspicious recently.


Medical History




She has been an insulin dependent diabetic since the age of 18 and is careful about her diet and lifestyle. Her blood glucose levels have always been between 4 and 7 mmol/l and with the exception of a single episode of hypoglycaemia, she has had no problems with her diabetes.

Allergies : Nil

Medication




Human Mixtard 30/70: 32 units at breakfast; 18 units at tea

Family History : -

Social History

Drinks alcohol very occasionally. Non smoker.

Category:

Education

Tags:

• Medical cases
• DM
• diabetics