Clinical Case Vignette Workbenches
Multi-investigation patient scenarios teaching step-by-step diagnostic pattern recognition.
Featured Clinical Cases
Severe Acidosis & Dehydration in a Young Adult
22-year-old female with Type 1 Diabetes Mellitus
History of Presenting Illness:
Vomiting, abdominal pain, deep rapid breathing, and lethargy for 24 hours. Missed her evening glargine insulin due to gastrointestinal upset. Now unable to keep liquids down.
Physical Examination Findings:
- BP 92/58 mmHg, HR 124 bpm, RR 32 /min (Kussmaul breathing), Temp 37.1°C, SpO2 98% on room air
- Fruity breath odor (ketones), dry mucous membranes, delayed capillary refill (3.5s)
- Diffuse abdominal tenderness without guarding or rebound
Initial Diagnostic Panel & Investigation Results:
| Investigation | Result | Flag |
|---|---|---|
| Capillary Blood Glucose | 28.4 mmol/L (512 mg/dL) | CRITICAL |
| Arterial Blood Gas | pH 7.10, PaCO2 18 mmHg, PaO2 96 mmHg, HCO3 5 mmol/L | CRITICAL |
| Serum Sodium (Na+) | 130 mmol/L | ABNORMAL |
| Serum Potassium (K+) | 5.6 mmol/L | ABNORMAL |
| Serum Chloride (Cl-) | 92 mmol/L | NORMAL |
| Serum Anion Gap | 33 mmol/L (Normal 8-12) | CRITICAL |
| Urine Dipstick | Glucose 4+, Ketones 4+, Nitrite Negative | CRITICAL |
Diagnostic Decision Question:
Evaluate the acid-base disorder using Winter's formula and Delta-Delta. What is the precise diagnostic categorization and initial fluid resuscitation?