Chief complaint:
After a long day of bailing hay, patient fell asleep and was un-arousable in the morning.
History of present illness:
Patient is a 18-year-old Caucasian male who came in after referred from the ER after 2 bouts of unconsciousness caused by hyperglycemia and dehydration. “I had a long day of working out on the farm and went to bed that night feeling fine. The next day, I woke up in an ambulance. My mom said she tried to wake me up for school but I would not wake up so she called 911.” The patient’s mother also reported frequent urination and “sticky” urine as she said, “it has been sticking to the toilet seat bowl”, as well as recent weight loss.
Previous Medical History:
- Appendectomy, age 10
- 2 episodes of hypoglycemia, ages 11, 15
Pertinent Family History:
- Father, age 47, squamous cell carcinoma
- Mother has no medical conditions, healthy at age 45
- Brother, age 15, no medical conditions
- Paternal grandfather, age 72, late-onset dementia
- No family history of diabetes
Pertinent Social History:
- Just completed high school in June and will be attending college in the fall
- Helps with family farm in addition to working weekends at the local grocery store
- Played running back for the high school football team
- Denies smoking or alcohol use
- Very active, enjoys spending time with friends and family
Allergies:
- No known allergies
Medications:
No current medications.
Focused Physical Exam:
Foot exam: lower extremity sensory neuropathy, detect ulcers and infection
Fundoscopic exam: retinopathy; if hemorrhages or exudate, refer to opthamologist (Khardori).
Vitals: respiratory rate-Kussmaul’s respirations with DKA, orthostatic hypotension, relative tachycardia
Muscle function: impaired function, decreased ROM especially in abduction and lateral rotation-adhesive capsulitis, or frozen shoulder (Ahmad, 2012)., carpal tunnel (Redmond, 2009).
Skin: Cheiroarthropathy: development of periarticular thickening of skin on the hands and limited joint mobility (Larkin, 2014).