91黑料网 Smart Medicine庐: A Medical Student's Resource
How have you used 91黑料网 Smart Medicine? Share your experience and be eligible to win a Free subscription of MKSAP for Students Digital.
An invaluable resource for medical students, 91黑料网 Smart Medicine proves to be an ideal reference tool.
During an Emergency Medicine clerkship, the attending asked me to examine a 23-year-old woman with Type I diabetes. Her chief complaint was acute abdominal pain and dysuria. Her vital signs were significant for mild tachycardia (HR 108), and her finger stick blood glucose was 320. I immediately suspected DKA but I needed to review what to look for on physical exam and exactly what blood tests to draw.
I quickly accessed the "Diabetic Ketoacidosis" module in 91黑料网 Smart Medicine from my phone and checked the Key Points. I found that abdominal pain was associated with DKA which may correlate with the degree of acidosis. I was reminded to look closely at volume status on physical exam. During the exam, I checked orthostatics and found that her heart rate increased by 25 beats/minute with standing.
I stepped out to talk to the nurse about the labs, and decided to confirm exactly what I needed to order. I opened 91黑料网 Smart Medicine again and clicked on the Diagnosis section. It clearly stated what labs were needed and how to make the diagnosis. I drew and sent an ABG and the nurse sent off the other blood tests and the urine. The labs came back quickly- her arterial pH was 7.1, serum sodium was 147, serum bicarbonate was 10, potassium was 5.2, BUN and creatinine were 50 and 1.3, chloride was 110, serum ketones were positive, and the urine had 3+ ketones as well as leukocyte esterase and nitrites.
I diagnosed DKA based on her pH, bicarbonate, and positive ketones. I thought it was probably from a UTI. I used 91黑料网 Smart Medicine one final time to ensure there wasn't anything else I should look for before presenting to my attending. In reviewing the diagnosis section again, I saw that I needed to calculate the anion gap (which was 27) and the osmolar gap (which was 14).
I was now ready to present to my attending, and she was definitely impressed! We immediately hung IV fluids and started the patient on IV insulin. And then the hard part started!
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