Postgrad Med J 1999;75:753-754
( December )
Self-assessment questions
A respiratory complication of diabetic
ketoacidosis
N Younis, M J Austin, I F Casson
Department of
Diabetes and Endocrinology, Royal Liverpool and Broadgreen University
Hospital, Liverpool, UK
Accepted 28
April 1999
| The first 150 words of the full text of this article appear below. |
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Introduction |
A 37-year-old man with type 1 diabetes presented with
a few days history of persistent vomiting and lethargy associated with thirst and polyuria. He was not on any regular medication apart from
insulin. He had omitted his insulin over the last 24 hours.
Clinical examination revealed him to be dehydrated with a tachycardia
of 120 beats/min and blood pressure 130/80 mmHg. He was dyspnoeic with
a respiratory rate of 32 breaths/min; the pattern was characteristic of
Kussmauls respiration. Laboratory investigations showed a metabolic
acidosis with arterial blood gases pH 7.08, bicarbonate 10.7 mmol/l,
base excess -22.6 mmol/l and plasma glucose 32.4 mmol/l. Ward testing
for urinary ketones was strongly positive (+++ by ketostix). A chest
X-ray was performed
(figure).
| Figure Removed (Available Only in the Full Text) |
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Questions |
| 1 |
What does the chest X-ray show?
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| 2 |
What clinical signs would you look for?
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Answers |
QUESTION 1
The chest X-ray shows mediastinal emphysema with characteristic
lines of radiolucency around the mediastinal pleura. There is also
radiological evidence of subcutaneous emphysema in the soft tissues in
the neck.
QUESTION 2
Surgical emphysema is . . . [Full text of this article]
