[Expert Solution]: Mrs Sandra Mirza is a 24-year-old lady…

Mrs Sandra Mirza is a 24-year-old lady presenting to the emergency department at 1900hrs with nausea, vomiting, malaise for 2 days. Decreased oral intake. Vague historian. Denies urinary or bowel symptoms. Denies cough, chest pains or fevers. Currently breastfeeding 4 months old infant. Husband reports patient has history of Type I Diabetes, variable insulin compliance- not measured BGL for last 2-3 weeks, and not taking insulin regularly for the last 2-3 weeks as patient is trying ‘home remedies.’ Non-Medicare, BUPA health insurance. Past Medical History: Type I Diabetes, ?nil community follow-up Lower Segment Caesarean Section-postpartum 4 months Current Medications: Inj Levimur 4U nocte, Inj Novarapid 3U TDS, Ferograd 1 tablet daily Nursing Assessment at 2000hrs: A. Patent, own B. RR-37/mt, SPO2-99% on 2L NP. Spontaneous, fruity odour breath, some increased work of breathing, chest clear, good air entry B/L, no adventitious lung sounds. C. Heart Rate Regular- 145/mt, tachycardic. BP- 90/58 mmHg. Capillary Refill Time 3 sec, heart sounds dual no murmur. D. GCS-14/15 E4V4M6, anxious and distressed + E. Afebrile. Dry mucous membrane +++ Abdo: soft and non-tender, bowel sounds present, IVCx2 Rand L antecubital fossa in situ, IVCx1 L arm. F. IVF fluids in progress, Nil by mouth, ice chips. G. BSL- 28.7 mmol/L (on arrival BGL- Hi), Ketones- 7.9 mmol/L Venous blood gas at 1930 hrs pH- 6.83 Weight: 56 kg Lab Results: Sodium Potassium Chloride Magnesium Phosphate Haemoglobin White blood cells Neutrophils Platelets C Reactive Protein (CRP) 139 mmol/L 4.4 mmol/L 107 mmol/L 0.88 mmol/L 1.54 mmol/L 145 g/L 16.0×10^9/L 11.0×10^9/L 468×10^9/L 7 mg/L 135-147 mmol/L 3.5-5.2 mmol/L 95-107 mmol/L 0.8-1.10 mmol/L 0.75-1.50 mmol/L 120-140 g/L 4.0-11.0×10^9/L 2.0-7.5×10^9/L 150-400×10^9/L <3mg/L 7.35-7.45 80-100 mmHg 35-45 mmHg 22-26 mmol/L >95% -2 to +2 mmol/L 0.5-1.6mmol/L >= 90mL/min/m2 Result Reference Range Arterial blood gas analysis (at 2200hrs) pH 7.05 PaO2 139 mmHg PaCO2 9 mmHg HCO3- 2 mmol/L SpO2 98% BE -27.9 mmol/L Lactate 3.0 mmol/L GFR >90 mL/min/m2 Result Reference Range Clinical Impression: DKA, precipitant likely noncompliance with insulin+? viral illness Plan: 1) Transfer to ICU within 1 hour 2) Chase urine and blood culture results 3) Continue current Normal Saline infusion 4) Continue DKA protocol: Continue current insulin (Actrapid) infusion at 5u/hr Hourly BGLs, ketones, 2-hourly VBGs, Potassium replacement as per protocol. 5) ECG 6) IDC to be inserted 7) Nurse manager to organise bed boarding for baby 8) Endocrine review Question 1 (600 words) Explain the pathophysiology leading to all the clinical manifestations with which Mrs Mirza presents. Please use information from diagnostic results where relevant.