442 CHAPTER 9• Endocrine and Nervous Systems
Reading
Practice pronunciation of medical terms by reading the following medical report aloud.
Diabetes Mellitus
ADMITTING DIAGNOSIS:Diabetes mellitus, new onset.
DISCHARGE DIAGNOSIS:Type 1 diabetes mellitus, new onset.
HISTORY OF PRESENT ILLNESS:Patient is a 15-year-old white boy who presented in the office complaining
of increased appetite, polydipsia, and polyuria and was found to have elevated blood glucose of 400 and glycosuria.
He was sent to the hospital for further evaluation and treatment.
HOSPITAL COURSE:On admission, laboratory tests showed electrolytes, WNL, and ketones were negative. Urinalysis
showed a trace of glucose, BG 380, and there was no evidence of acidosis. Metabolically the patient was stable. Patient was
started on split-mixed insulin dosing. The patient and his family received full diabetic instruction during his hospitalization
and seemed to understand this well. The patient picked up on all of this information quickly, asked appropriate questions,
and appeared to be coping well with his new condition. By the 5th day, his polyuria and polydipsia resolved. When the
patient was able to draw up and give his own insulin and perform his own fingersticks, he was discharged.
DISCHARGE INSTRUCTIONS:The patient was discharged to home with parents on a mixture of Humulin L 12 units
and Humulin R 6 units each morning, with Humulin L 5 units and Humulin R 6 units each afternoon. He will continue
with fingerstick BG 4 times daily at home until seen in the office for follow-up. I warned him of all glycemic symptoms to
watch for, and he is to call the office with any problems that may occur. He is to follow an ADA 2,000-calorie diet.
DISCHARGE CONDITION:The patient’s overall condition was much improved, and at the time of discharge
BG levels were stabilized and he was doing well.
Evaluation
Review the medical record to answer the following questions. Use a medical dictionary such as Taber’s Cyclopedic
Medical Dictionaryand other resources if needed.
- What symptoms of DM did the patient experience before his office visit?
- What confirmed the patient’s new diagnosis of DM?
- What conditions had to be met before the patient could be discharged from the hospital?
- How many times a day does the patient have to take insulin?
- Why does the patient have to perform fingersticks four times a day?
- What is an ADA 2,000-calorie diet? Why is it important?