A 62-year-old male with type 1 DM (DM-1) treated with fast-acting soluble human insulin and smoker of 20-30 cigarettes/day.
The patient has an unwanted appearance.
He lives only in the countryside and is considered a "ermitany", although he has a good relationship with the close people.
She came to the hospital emergency department due to a change in her general condition.
She has high blood glucose levels, despite having decreased food intake, which she cannot control with her usual insulin regimen.
Acquired a picture of diarrheal stools in recent days, in addition to polydipsia.
He also mentions a clinical picture of colic, diffuse abdominal pain of undetermined evolution time, which does not relate to the current picture.
Upon arrival, the patient was hemodynamically stable, but had elevated capillary glucose levels (CG:
The patient's dissatisfied and deteriorated aspect draws attention to the exploration, although it is conversationally impressed by someone else's self-examination.
The abdomen was blushing, depressible, with diffuse pain upon palpation, negative Murphy and Blumberg, and there were no signs of peritoneal irritation.
Duplicate mass in the right hemiabdomen.
Treatment was initiated with paracetamol, serum therapy and pump.
Analytically the patient has a blood count with 22,400 leukocytes and 18,900 neutrophils; the biochemistry shows a glucose of 555 mg/dl, creatinine 2.11 mg/dl, urea 91 mg/dl, Na+34 mmol/L blood gas
These analytical findings are justified by the start of the correction of the patient.
A chest x-ray (Rx) was performed, which was normal, and an abdominal X-ray was performed.
After the abdominal X-ray findings are discussed with the radiologist of the day care center, who advises the performance of an abdominal ultrasound, observing an 11 cm long gall bladder with multiple stones and thickening of the wall.
1.
With the diagnosis of diabetic ketoatosis secondary to acute onset seizures, an interconsultation is made with the General Surgery Department, who decide to intervene in the emergency department.
At first, the patient refuses to undergo the intervention.
At that time, both residents responsible for the patient began to explain the risk of not performing the intervention and its possible consequences.
After 90 minutes of conversation, answering the patient's questions and trying to make him understand how important the intervention is for the resolution of the process, the patient accepts the surgery.
After surgery the patient is sent to a surgical ward where he evolves favorably.
After medication readjustment by endocrinology, the patient was discharged with controlled blood glucose levels and a more current regimen than he used.
