Mr. Hassan, a 45-year-old diabetic patient, felt severe epigastric pain and repeated vomiting and sweating. He was admitted to the hospital where tests found very high blood sugar, ketones in his urine, and abnormal electrolyte and blood gas levels. The diagnosis was a myocardial infarction complicated by diabetic ketoacidosis due to stress from the heart attack. He was admitted to the intensive care unit for monitoring, treatment of his conditions, and consultation with cardiology for potential intervention due to his history of heart disease.

1. Case Study
Mr Hassan is your diabetic patient , aged 45 years and suffer from diabetes
Since 5 years , he ring you this morning because he feel severe epigastric
.Pain associated with repeated vomiting and Sweating
Ask the patient 3 questions before you advice him
Remind me about your treatment
Do you have any other $ diarrhea, chest pain
Make random sugar and call me immediately
No diarrhea
Random sugar is HHH

2. ,Mr Hassan you have to be admitted to Hospital immediately
once their let the physician to call me
In the ER the physician , after a short history ,and checking vital signs
recommend the Nurse to take the followings
Random Sugar
Bp 90/60
Pulse 100 regular
Temp 37.5 C
ABG arterial sample
Iv root and take an enough venous sample
Urine
ECG

3. Work blood for
• Random sugar
• Urine for sugar and acetone
• Electrolytes
• Renal function,hepatic function
• CBC
• Serial Troponin HS, cardiac enzymes
• Urine and Bld culture
• ECG
• Chest radiology and US bed side

4. DD
• MI
• DKA
• Hypoglycemia
• Ketosis (starvation, Alcoholic, Pregnancy)
• Acute Abdomen
• Gastroenteritis
• Others

5. Severity of the condition
• Po2, Pco2, O2 saturation
• pH
• Hco3
• Anion gap
• Osmolality
• State of consiousness
• PPT factor MI, infection, stroke

6. The following patient data
• Random Sugar 600mg%
• Urine Sugar +++, acetone++
• K 5.2mEqu/L
• pH 7.3
• Hco3 15
• Anion gap 16
• Osomolality 300
• Creatinine 1.2
• CBC leukocytes 12.000
• Troponin +ve (2nd analysis)
• ECG Non Q wave infarction

8. Diagnosis
• MI
• MI+DKA (stress)
• HHS
• Others

9. Admission in ICU,CCU
• Monitor
• Treatment of ppt condition
• Cardiology Consultation & intervetion
• Fluid ressusitation (MI, CVP)
• Electrolytes
• Insulin

10. Mr Hassan known to have IHD
• Intervention
• Fibrinolytic agent
• Heparinization
• Antiplatelets
• Hydration CVP
• O2

11. Expected complications
• Cardiac complications MI
• Hypoglycemia
• Prolonged DKA
• Brain edema
• Thromboembolic
• Renal failure
• ARD syndrome
• Arrhythmias

12. Hyperglycemic crises
is it preventable
• yes
• How
• Patient health education
• Improvement diabetes care