Answer
Ms. Morgan is in diabetic ketoacidosis (DKA). She should be given insulin intravenously.
Work Step by Step
All the signs of the patient indicate a condition called diabetic ketoacidosis.
This is caused by there not being sufficient insulin available in the patient's body for cells to absorb normal amounts of glucose . When cells are unable to absorb enough glucose, they metabolize fats as an alternative fuel. But the metabolism of fats leads to ketones as bi-products and to formation of ketoacids. As the pH of the blood falls, the body tries to compensate by getting rid of more carbon dioxide. The acetone "fruity" smell is due to ketones, and the rapid Kussmaul breathing is an attempt to restore pH homeostasis after the blood pH has fallen below 7.2.
The patient should be given insulin intravenously(i.v.) to reduce her blood sugar level to below 240 mg/dL(normal blood sugar range is 70-100 mg/dL). The patient should also be given fluid and electrolytes replacements, either i.v. or by mouth.
