ESIION
1.
Mr. Livingston is a 79-year-old male who presents from a long term care facility wit
change in mental status. His medical history is significant for T2DM, CAD, CHF,
hypothyroidism, Alzheimer’s dementia and osteoarthritis. He has been stable, but over th
last few days the staff say he has been a bit disconnected. This morning he was found in
bed in a stuporous state. His vital signs include a temperture of 98.9 F, pulse of 103 b.p.
respiratory rate of 20 b.p.m., and a blood pressure of 92/64 mm Hg. His metabolic panel
demonstrates a Na+ of 129 mEq/L, K+ of 3.3 mEq/L, CI- of 100 mEq/L, CO2 of 24 mEq/L,
glucose of 644 mg/dL, BUN of 51 mg/dL and creatinine of 1.9 mg/dL. The AGACNP knows
that the primary problem is most likely:
A Diabetic ketoacidosis
O