“I feel weak and am short of breath.”
History of Present Illness
PJ is a 23-year-old Caucasian female who is brought to the emergency department (ED) by her mother for generalized weakness and deep, labored breathing. She complains of having polyuria, polydipsia, diminished appetite, nausea and vomiting, and abdominal pain for the past 2 to 3 days. Patient denies fever, chills, heartburn, melena, hematemesis, diarrhea, or constipation.
Patient states that she was diagnosed with diabetes mellitus type 1 about 3 months ago, at which time she received prescriptions for insulin degludec, insulin lispro, and lisinopril. She admits to not picking up the insulin degludec due to cost. However, she does have insulin lispro and lisinopril at home. She states that she has been taking her lisinopril, but not her insulin lispro. At this previous visit, she was also instructed to schedule an appointment with an endocrinologist and a registered dietitian; however, she has not done either.
Type 1 diabetes mellitus, microalbuminuria
Father with type 1 diabetes
Occasional EtOH use (drinks socially on the weekends).
Up-to-date with childhood vaccinations, including hepatitis B vaccination series
Insulin degludec 15 units subcutaneous every day at bedtime
Insulin lispro 5 units subcutaneous every day prior to each meal
Lisinopril 10 mg PO daily
Nexplanon® 65 mg subdermal (inserted 6 months ago)
Temp 98.1°F, HR 118 bpm, RR 28 breaths per min, BP 88/64 mmHg, O2 sat 92%, Ht: 5′5″, Wt: 54.5 kg
Altered, lethargic female
Normocephalic, PERRLA, EOMI
SOB, (+) Kussmaul respirations, fruity breath
Tachycardic, hypotensive, weak pulse, NSR, no m/r/g
Mild abdominal tenderness, (+) bowel sounds
Drowsy and altered, A&O × 2 (person and place)
Dry mucous membranes, poor skin turgor, increased capillary refill time