Case Study 2: Ms. Jaffi
Story:
Ms. Jaffi is a 55 year old woman with a long standing history of DM 1 & Crohn’s
disease. She has been taking Pentasa for 15 years which has been controlling her IBD.
She is underweight; at 5’2 she weighs 92 lbs. She has lost 20lbs over the last 10 years
and has an average of 5 loose stools per day. Her diabetes has remained relatively
stable despite the challenges posed by her Crohn’s disease. After an episode of chest
pain last year, she was diagnosed with CAD, other than 3 resolving episodes of chest
pain she has had no further complications. Ms. Jaffi feels her life has become
dominated by health challenges and states she feels ‘down’ as a result. She is currently
dating a male friend whom she is reluctant to become closer to because of her health
issues.
She presented to the ED with a chief complaint of weakness & lethargy. The
following history was provided





Decreased stools x 2 -3days
Nausea, vomiting x 2 days
RLQ pain rates 6/10
Abd bloating/distension and pain
Polyuria & polydipsia x 2 days
Vital Signs:
T 37.5 ( oral) P 116, regular and thready , RR 27/min and shallow, BP 90/60 02
Saturation 95 % on Room Air
PMH includes:
 DM 1 (diabetes mellitus type 1)
 Crohn’s disease
 CAD (coronary artery disease)
 HTN (hypertension)
Current Home Medications:
 Ramipril 10 mg OD po
 Pentasa 500mg PO QID
 NTG spray 0.4 mg SL q5min x 3 for chest pain
 Metoprolol 25mg OD po
 Novolin 30/70 22 units qam sc/Novolin NPH 10 units qpm sc
Initial labwork in ED showed the following:
wbc 13000
differential normal
hgb 124
glucose: 35 mmol/L
K+ : 5.3 mmol/L
BUN & creatinine slightly elevated
Urine glucose 3+
Urine ketones 3+
Abg’s
pH 7.20
pco2 35
hco3 16
po2 92
hgb 124
sao2 97
Provider orders
1. Admit to Dr. Attala with exacerbation of Crohn’s disease and DKA
2. AAT
3. NPO
4. IV NS 1L bolus then IV NS 40 meq kcl/L @ 200cc/hr
5. Novolin Regular 100u/250 mL NS 0.1u/kg/hr
6. CBG q1h and prn
7. NG tube to low intermittent suction
8. Replace NG losses Q8H 1:1 with IV NS
9. Hold PO meds for now
10. Morphine 2 – 5 mg IV Q4h prn
11. CT abdomen
12. Lytes, BS, ABG’s Q2h call MD with results
13. Surgical consult