Multisystem Processes & Disorders

{"ops":[{"insert":"Diagnosis and reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"This middle aged man has presented with fever and progressive leg swelling, in a background of poorly controlled diabetes mellitus.\n\nExamination reveals the left lower limb to be erythematous and tender, with ipsilateral inguinal lymphadenopathy; this appears to be acute cellulitis.\n\nNote also the presence of altered mentation and a blood pressure \u2264100 mmHg; his qSOFA score is 2 points, indicating that he is likely to be septic.\n\nGiven his comorbidities, this is highly concerning; sepsis may instigate acute kidney injury (AKI), give rise to acid-base disturbances, and precipitate diabetic emergencies, such as a hyperglycemic hyperosmolar state (HHS).\n\nHis renal functions turn out to be only mildly deranged, with the disproportionately elevated blood urea nitrogen (BUN) being most likely secondary to dehydration. However, his random plasma glucose is markedly elevated to 465 mg\/dL, raising concern for HHS.\n\nThat said, calculation of the serum osmolality via the formula (2*Na) + (gluc"}]}

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