Case #3 (Macazo, Manueke, Purba)

A 14-year old boy, high school student was brought to the school clinic because of
abdominal pain and vomiting. One week ago, he was advised by his adviser to consult with the
school physician because of increase in the frequency of urination, wherein he excuses himself
from his classes to go to the comfort room at least twice in an hour; he was found out to have an
elevated random blood sugar (280mg/dL). He was advised further work-ups but until this time,
he hasnt gone back to the doctor. On further history-taking, he claims of feeling weak even with
no strenuous activity.
The patient has no previous hospitalizations nor surgeries, no medications currently
being taken. The boy had mumps last Christmas vacation. He denies smoking and intake of
alcoholic beverages. He is not aware of any illness in the family.
ROS: No fever, (+) easy fatigability , (-) blurring of vision, no dyspnea, orthopnea,
paroxysmal nocturnal dyspnea, no cough nor colds, no change in bowel habits, no bleeding
tendencies
On physical examination, the patient is conscious, coherent, ambulatory, not in cardio-
respiratory distress. His present weight is 40 kgs. His weight last October was 45 kgs. Vital signs
are BP 90/70 PR 100/min RR 27/min afebrile. Skin is warm, with pink palpebral conjunctivae,
anicteric sclerae, dry lips and tongue; supple neck, with no neck vein engorgement, no palpable
cervical lymph nodes. He has symmetrical chest expansion, no retractions, tachypneic with clear
breath sounds; adynamic precordium, apex beat at the 5th LICS MCL, normal rate, regular
rhythm, no murmurs appreciated. The abdomen is flat, with generalized muscle guarding and
normoactive bowel sounds. Extremities are without any edema nor any gross deformities.

Laboratory work-ups:
CBC Normal Values Results
Hemoglobin 153 g/L
Hematocrit 0.47
WBC count 9.81
Segmenters 0.80
Lymphocytes 0.16
Monocytes 0.02
Bands 0.02
Eosinophils
Basophils
Platelet count 250 x 109/L

ARTERIAL BLOOD Normal Values Results

GASES
pH 6.887
pCO2 8.5
pO2 121
HCO3 1.6
O2 saturation 96%
 URINALYSIS Normal Values Results
Color Light yellow
Transparency Slightly turbid
pH 5
SpecificGravity 1.015
Albumin Negative
Sugar +4
Hyaline cast None
Pus cells 0-1/hpf
RBC 0-1/hpf
Bacteria Few
Mucous threads Few
Amorphous urates Few
Ketones +3

CHEST X-RAY (PA): normal chest findings

Normal Values Results

RBS 310mg/dL
Sodium 138mEq/L
Potassium 4.5mEq/L
BUN 22.5 mg/dL
Creatinine 2.9 mg/dL

Competencies:
State the acute complications of DM
- detect the presence of signs and symptoms associated with the acute
complications of DM
- decide on the laboratory and/or ancillary procedures needed to support
the diagnosis of the acute complication
- develop a therapeutic plan for any of the acute complications
- predict, detect, prevent and manage the possible problems associated
with the acute complication