'Safety' technology: A hidden cause of diabetic ketoacidosis

摘要

A 74-year-old woman with type 2 diabetes was transferred from a long-term care facility to an acute care hospital because of a three-day history of nausea, vomiting and decreased oral intake. She denied any other symptoms. Fourteen days earlier, she had been transferred to the long-term care facility from a rehabilitation facility where she had been residing for six months while recovering from a stroke. Her medications included insulin glargine and insulin aspart. At the emergency department, her heart rate was 135 beats/min, blood pressure was 100/89 mm Hg, respiratory rate was 18 breaths/min, oxygen saturation was 98% on room air and temperature was 36.4°C. Physical examination showed neurologic findings of her previous stroke and no focus of infection. Results of laboratory testing included a blood glucose level of 36.0 (normal 4.0-7.8) mmol/L, an anion gap of 17 (normal 8-16) mmol/L and positive serum ketones.