Evidence-Based Approach on Assessing Polydipsia and Polyuria

Case Study
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* What are the pertinent positive and negative findings in this patient assessment?
The pertinent positives include dizziness and nausea for four days, associated with polydipsia and polyuria. The first two symptoms are aggravated by standing up and relieved by maintaining a supine position. The patient suffered from a cerebrovascular accident and has a history of diabetes, hypertension, and coronary artery disease. The blood pressure, cardiac rate, and blood sugar are above typical values. The pertinent negatives include the lack of blurring of vision, headache, standard respiratory rate, and normal temperature.
* Create a list of differentials with rationales for this patient?
1 Diabetic ketoacidosis (DKA)
It commonly presents when the blood sugar levels are between 250mg/dL to 800 mg/dL and is common in patients who are not compliant with medications. It presents with dizziness and nausea secondary to electrolyte imbalances (Gallo de Moraes & Surani, 2019). A pulse rate of more than 100 bpm is also suggestive of DKA (Evans, 2019). Older patients may also present with hypotension due to vascular abnormalities (Lizzo et al., 2021).
2 Hyperosmolar hyperglycemic syndrome
This is characterized by dizziness, weakness, vomiting, hypotension, and reflex tachycardia, all present in the patient, except that the hypotension is probably orthostatic. The risk factors include medication non-compliance, type 2 diabetes mellitus, and a previous cerebrovascular accident (Stoner, 2017).
3 Hypertensive urgency
This is defined by a systolic blood pressure of 180mmHg or more or diastolic blood pressure of 110mmHg or more, with associated symptoms such as nausea, vomiting, and malaise, all present in the patient (Campos et al., 2018).
* Discuss a medication regimen for this patient considering his financial status?
The general management includes hydration to restore circulatory volume, correct electrolyte imbalance, and if with ketones, clearance is necessary. Initially, the patient will be treated at the hospital with a continuous infusion of intravenous insulin at 0.14 U/kg/hr. When the blood glucose level reaches between 200-250mg/dL, intravenous fluid with 5% dextrose should be started if the patient has an anion gap, with continuous insulin titration depending on the blood glucose levels (Lizzo et al., 2021).
The treatment regimen for the maintenance phase can be reconsidered for financial purposes. A combination of sodium-glucose transporter-2 (SLGT-2) inhibitors and a biguanide, such as metformin, may be given in a dual or triple therapy. The patient should be advised to buy generic over branded drugs (Hsia et al., 2017). Triple therapy may be an alternative to insulin if the patient cannot afford it since this shows reasonable glycemic control in many patients (Padhi et al., 2020). Dietary changes and increased physical activity are also beneficial in the maintenance phase (Wang et al., 2020).
* What is the priority concern for this patient?
Since the patient has a history of ischemic CVD and CAD, the primary concerns include high blood pressure, which may precipitate another episode of CVD or sudden cardiac death ...