Phase 1 A 5 year old is brought to her pediatrician for an annual routine checkup. Her grandparents, who are also the legal guardians, are with her. The child has not seen her pediatrician in a year. The child recently had a visit to the urgent care center and was treated for strep throat. The grandparents are concerned about the child’s weight gain. They state no matter how much she eats she cannot gain weight and is hungry all of the time. Phase 2 The primary care office does not have a glucometer available, so the provider orders a urinalysis dip stick test. The urinalysis shows a glucose of over 500mg/dl with blood, leukocytes, and ketones. The results are shared with the grandparents along with the potential diagnosis and complications. The child’s grandparents are visibly upset and start asking the nurse questions about their grandchild. Choose the most likely options for the information missing from the statements below by selecting from the lists of options provided. Bases on the available test results the nurse suspects the child may be experiencing _____, because of _____ and _____ in the urine. The nurse anticipates that the child will need _____ and _____ as soon as possible.

Based on the available test results, the nurse suspects the child may be experiencing diabetic ketoacidosis because of ketones and glucose in the urine. The nurse anticipates that the child will need IV fluid replacement and IV regular insulin as soon as possible. Rationale: Diabetic ketoacidosis (DKA): The presence of both glucose (over 500 mg/dL) and ketones in the urine is a key indicator of diabetic ketoacidosis (DKA). DKA is a serious complication of diabetes mellitus, particularly type 1, where the body starts breaking down fats due to a lack of insulin, resulting in the production of ketones. When ketones build up in the blood, it leads to metabolic acidosis and a variety of other complications. Ketones: High levels of ketones in the urine indicate that the body is unable to use glucose for energy and is instead breaking down fat. This is common in DKA, where the lack of insulin leads to fat breakdown and ketone production. Glucose: The presence of glucose in the urine (glucosuria) suggests hyperglycemia, which is another hallmark of diabetes mellitus and typically present in diabetic ketoacidosis. Treatment: IV fluid replacement: In DKA, dehydration is common due to excessive urination from high blood sugar. IV fluids are administered to rehydrate the body and restore normal fluid and electrolyte balance. IV regular insulin: Regular insulin is essential to lower the blood glucose level and stop the body from producing ketones. Insulin is administered via IV to quickly bring the glucose levels under control and prevent further production of ketones.