Case Analysis: Diabetes (900 words)

Ms. Blake is an older adult with diabetes and has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time. On admission her laboratory values show:

Ms. Blake’s values
Sodium (Na+)                         156 mEq/L
Potassium (K+)                        4.0 mEq/L
Chloride (Cl–)                         115 mEq/L
Arterial blood gases (ABGs)    pH, 7.30; PCO2, 40; PO2, 70; HCO3– , 20

Normal values
Sodium (Na+)                            136-146 mEq/L
Potassium (K+)                           3.5-5.1 mEq/L
Chloride (Cl–)                            98-106 mEq/L
Arterial blood gases (ABGs)       pH         7.35-7.45
                                                    PCO2   35-45 mmHg
                                                    PO2      80-100 mmHg
                                                    HCO3– 22-28 mEq/L
What type of water and solute imbalance does Ms. Blake have? Look closely to the labs. What can explain the labs? This patient has diabetes what are the possible complications of diabetes? Lastly, why did she become bedridden.? Please give five differentials and discuss each item on your differential.
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Interpretation of data: The lab data shows that electrolytes such as sodium and chloride are above than normal range, where as potassium are found in normal range. The blood pCO2 is under the normal values. But blood pH, pO2 and HCO3- are below the normal values. These conditions are most likely referred and diagnosed as metabolic acidosis and relative dehydration.
Increase in sodium and chloride ion concentration referred as hypernatremia and hyperchloremia respectively. Decrease in pO2 referred as hypoxia. Decrease in pH and bicarbonate indicates metabolic acidosis.
The patient is diabetic so she may have complications such as kidney disease (nephropathy), eye complication (retinopathy), nerve damage (neuropathy), heart diseases, urinary frequency, fatigue, weakness, bone pain etc. The patient became bedridden due to weakness in body through hypernatremia, hyperchloremia and hypoxemia caused by dehydration, fluid loss...