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Case presentation Robin, a 54-year-old widower, who lived alone, was admitted to hospital after his son found him semiconscious at home. Robin had seemed well when he visited him one week earlier, but he recalled that Robin had been complaining of...

i. Differential diagnosis of Robin’s test results: Based on the provided laboratory results, we can consider the following potential diagnoses:

  1. Hyperosmolar Hyperglycemic State (HHS): The extremely high glucose level (55 mmol/L) along with dehydration and elevated osmolality suggests HHS. The low bicarbonate level may be due to compensatory mechanisms.

  2. Diabetic Ketoacidosis (DKA): Although DKA typically presents with acidosis, it cannot be ruled out completely as the pH value is not provided in the case. However, the absence of ketones in the blood sample may make DKA less likely.

  3. Renal dysfunction: The elevated urea level could indicate renal dysfunction leading to impaired urea excretion.

ii. Additional tests for confirmation: To confirm the diagnosis, further tests that can be considered are:

  1. Arterial blood gas analysis: This will help assess acid-base balance and determine if there is any metabolic acidosis.

  2. Serum lactate levels: Elevated lactate levels could indicate tissue hypoperfusion or impaired oxygenation.

  3. C-peptide levels: Measuring C-peptide can help differentiate between type 1 and type 2 diabetes by assessing endogenous insulin production.

  4. i. Recommendations for managing Robin’s disorder: Based on the diagnosis of Hyperosmolar Hyperglycemic State (HHS), the following recommendations can be made to better manage his disorder:

  5. Fluid replacement therapy: Intravenous fluid administration to correct dehydration and restore electrolyte balance.

  6. Insulin therapy: Regular insulin infusion should be initiated to bring down hyperglycemia gradually.

  7. Monitoring vital signs and laboratory parameters: Regular monitoring of blood glucose, electrolytes, renal function, and fluid balance.

ii. Testing Robin’s son for the same disorder: Considering that Robin is a widower with no significant past medical history, it is important to investigate the possibility of an underlying genetic component or hereditary condition. It would be advisable to have Robin’s son undergo appropriate medical evaluation, including a thorough medical history, physical examination, and relevant diagnostic tests. This will help determine if there is a familial predisposition or shared disorder that may require early intervention or preventive measures.


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