diabetes

HYPOGLYCEMIA – General

MDM

This patient presents with symptoms and labs consistent with acute hypoglycemia, most likely due to ***. Differential diagnosis includes ***. Considered other etiologies of acute hypoglycemia to include drugs (anti-hyperglycemics, alcohol, beta blockers, ACE-I, APAP) or drug related error (missed meal, incorrect dosing, intentional overdose), systemic illness (sepsis, acute coronary syndrome, renal / hepatic failure, adrenal insufficiency), malignancy, or post-op complications (i.e. Gastric bypass). Presentation not consistent with other acute, emergencies related to hypoglycemia.

Plan: serial POC glucose, hypoglycemia protocol treatment per routine, labs***, consider observation/admission, serial reassessment

HYPERGLYCEMIA – Lo Risk

MDM

This patient is a @AGE@ @SEX@, presenting with apparent acute hyperglycemia. Differential diagnosis includes ***. Considered DKA versus HHS, sepsis as possible etiologies of the patient’s current presentation. However, given the current history & physical, including current glucose level, the current presentation is consistent with acute, asymptomatic hyperglycemia. Plan to treatment supportively. No indication for further workup at this time.

Plan: supportive care, serial POC glucose monitoring, labs***, serial reassessment

DKA – Admit

MDM

This patient presents with hyperglycemia and symptoms concerning for DKA. Differential diagnosis includes other metabolic causes of hyperglycemia such as HHS, worsened diabetes or medication noncompliance. Considered possible causes of DKA to include infection (pancreatitis, UTI, pneumonia), infarction / ischemia (acute coronary syndrome, cerebral vascular accident), medication non-compliance with insulin therapy, illicit substance abuse, iatrogenic (including prescription medications and drug-drug interactions), idiopathic causes. Most likely etiology at this time is ***. Plan to treat the hyperglycemia as below while simultaneously evaluating and treating potential underlying etiologies.

Plan: POC glucose monitoring (Q1H), BMP (Q2H), blood gas, UA, serum ketones, CBC, LFTs / lipase, infectious workup (lactate/blood cultures, CHEST X-RAY)***, IVF, IV Insulin therapy, serial reassessment, admission for treatment of hyperglycemia