A 46-year-old Hispanic man (Mr. R) is admitted to the emergency room tonight. He has a 15 year history of type 1 diabetes. He is unconscious so his wife provides this history: On Friday (Day 1), he ate dinner out at an unfamiliar restaurant. He became ill that evening with vomiting. Although his wife ate the same food, she did not become ill. He omitted his bedtime injection of insulin because he had not kept down any food. He continued vomiting Saturday (Day 2) and Sunday (Day 3), again omitting all insulin injections because he had not kept down any food. During this time, his wife encouraged him to see, or at least to call, his physician, but he declined. He did not measure his blood glucose level because he had left his meter at work. He did not measure urine ketones because he had never been instructed to do so. His wife discovered him unresponsive on Monday morning (Day 4). His wife stated that they had learned about diabetes when he was initially diagnosed, but had not had any diabetes education since. He is diagnosed with Diabetic Ketoacidosis (DKA). His glucose level on admission is 576 mg/dl. His urine is positive for ketones. His ABG’s show this: pH 7.18; HCO3 10; CO2 30. Potassium is 3.4 mEq/L. Vital signs include: TPR 101-120-40 (deep, loud respirations and fruity smelling breath) BP 90/60. His skin is dry with poor skin turgor. A Foley catheter is inserted with return of 15 ml dark, concentrated urine. Oxygen is running at 4L per nasal cannula and he has an oxygen saturation of 98%. A Hgb A1c level was also drawn in the emergency room. 1. List the signs and symptoms that Mr. R manifested that are associated with the diagnosis of DKA. (0.5 points) 2. What is the cause of the symptoms you have listed above? (0.5 points) 3. Why was Mr. R at risk for development of DKA? (0.5 points) 4. How would the symptoms Mr. R is having differ if he were a patient with hyperglycemic, hyperosmolar state (HHS)? (1 point) 5. What do Mr. R’s ABG’s indicate about his acid base balance? Explain exactly wh
