Diagnostic dilemma| Volume 119, ISSUE 3, P238-240, March 2006

An Ominous Finding

      Mr. H., a 45-year-old African American man with a history of type 2 diabetes mellitus and alcohol abuse, was brought to the hospital by ambulance following 3 days of nausea and vomiting. En route to the emergency department, he was noted to have a decreased level of responsiveness, and a blood glucose test strip indicated elevated blood glucose levels. His initial systolic blood pressure upon arrival to the emergency department was 40 mm Hg by Doppler examination. An arterial blood gas measurement revealed a pH of 6.84. He was intubated, placed on mechanical ventilation, started on vasopressor support with dopamine, and transferred to the medical intensive care unit.
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