So this guy comes in confused. Seems to be a pretty commonplace occurrence. What was different this time is that this man was not drunk - he was a known diabetic.
After a while we got the story that he had not been taking his insulin for a few days as he wasn't feeling well and hadn't been eating.
His initial reading on the glucometer was "HIGH." It seemed pretty clear that we were looking at severe DKA. He was put on the monitor which revealed a wide complex sinus tach alternating with V tach. Yikes.
Well the good news is that his confused ramblings persisted even during the v tach.
The EKG showed huge T waves.
His initial pH was 6.9.
He got a gram of calcium gluconate, an amp of bicarb, insulin sub q and IV and his EKG started to normalize quickly.
After a while we got his labs. His potassium was 7.9 mmol/L.
Wow.
