Taj, a 12-Year-Old Boy with Hyperglycemia

CASE PRESENTATION Taj is a 12-year-old previously healthy boy who presents to the emergency department (ED) with nausea, vomiting, and abdominal pain. He also has recently experienced frequent urination and weight loss. On evaluation in the ED, Taj is tired and appears mildly uncomfortable but is alert and interactive. The ED physician obtains a fingerstick glucose level, which is elevated at 450 mg/dL (24.98 mmol/L). The physician administers a 20 mL/kg normal saline (0.9%) intravenous (IV) bolus and obtains laboratory tests, including venous blood gas (VBG), complete blood cell count, comprehensive metabolic panel, magnesium, phosphorous, hemoglobin A1c (HbA1c), and urinalysis. Taj’s VBG shows a pH of 7.25, Pco2 of 38 mm Hg, and base deficit of 14 mEq/L (14 mmol/L). The remainder of his laboratory test results are pending. The physician is concerned about diabetic ketoacidosis (DKA) and calls you to request that you evaluate Taj for admission.