top of page

Case Scenario: Diabetic Ketoacidosis (DKA) in a 16-year-old Patient

Updated: Mar 19



Summary:

This case scenario involves a 16-year-old patient presenting with symptoms of diabetic ketoacidosis (DKA) due to undiagnosed or poorly controlled type 1 diabetes mellitus. The primary challenge in this scenario is effective history taking, explaining the condition clearly, and persuading the patient to accept urgent hospital admission while respecting autonomy.

Key Points:

History Taking:

  • Ensure thorough signposting before asking personal questions (e.g., sexual history).

  • Rule out differential diagnoses like:

    • UTI (urinary symptoms)

    • Anorexia nervosa (weight loss, lifestyle concerns)

    • Malignancy (lumps, chronic fatigue)

  • Assess the impact on daily life, including school performance and concentration.

Explanation of Type 1 Diabetes and DKA:

  • Clearly explain that type 1 diabetes is an autoimmune condition where antibodies attack the pancreas, leading to insulin deficiency.

  • Describe symptoms in simple terms:

    • Increased thirst (polydipsia)

    • Frequent urination (polyuria)

    • Abdominal pain

    • Fatigue

  • Explain DKA as a life-threatening emergency:

    • Insulin deficiency leads to ketone production, which causes acid buildup.

    • If untreated, ketones can cause coma and death.

Emphasizing the Emergency:

  • Frame the urgency in a way that the patient understands.

  • Highlight severe complications:

    • Unconsciousness, coma, or even death if left untreated.

    • Reinforce why hospital admission is non-negotiable.

Important Considerations:

  • Patient autonomy: A 16-year-old can legally refuse treatment, so persuasion is key.

  • Parental involvement: Inform the parent, but do not override the patient’s decision.

  • Use of ICE (Ideas, Concerns, Expectations): Understanding the patient's fears (e.g., missing exams) can help tailor your explanation.

  • Ethical communication: Ensure the patient is well-informed and not coerced.

Diagnostic Approach:

  1. Clinical History & Examination

    • Assess dehydration, breathing pattern (Kussmaul respiration), and consciousness level.

  2. Essential Investigations

    • Blood glucose (elevated in DKA)

    • Urinalysis (ketones, glucose)

    • Blood gas analysis (pH <7.3, metabolic acidosis)

    • Electrolytes (check for hypokalemia)

Management Plan:

  1. Immediate

    • Admit to hospital immediately.

    • IV fluid resuscitation (normal saline initially).

    • IV insulin infusion (fixed-rate).

    • Electrolyte correction (especially potassium).

    • Frequent monitoring (glucose, ketones, pH).

  2. Long-Term

    • Diabetes education (insulin therapy, blood sugar monitoring).

    • Lifestyle advice (diet, exercise, sick day rules).

    • Psychological support if needed.

Communication Skills:

  • Use clear, non-technical language when explaining diabetes and DKA.

  • Address the patient’s concerns first (e.g., fear of hospitalization, missing school).

  • Reinforce key messages:

    • "This is an emergency. Without treatment, your body could shut down."

    • "We need to act fast to prevent serious complications."

  • Empathy and reassurance:

    • Validate concerns and fears while emphasizing medical necessity.

Ethical Considerations:

  • Autonomy vs. Beneficence: The patient has the right to refuse treatment, but the doctor must strongly advocate for lifesaving care.

  • Parental Involvement: While the patient can consent, the parent should also be informed for support.

  • Non-maleficence: Avoid scaring the patient excessively but be honest about risks.

留言

bottom of page