[29F] With severe lightheadedness and high blood sugar

Patient Description

A 29-year-old female presents with severe lightheadedness that started suddenly about an hour ago. The lightheadedness worsens upon standing and improves with sitting. She also reports feeling restless, experiencing frequent urination, and having nausea throughout the day. The patient has diabetes and recorded a recent blood sugar level of 586. She denies any fruity or acetone-like smell on her breath. Her medical history includes irritable bowel syndrome diagnosed in 2006 and gallbladder removal in 2007. Current medications include Pantoprazole 40mg daily, Amphetamine salts 10mg twice daily, Propranolol 20mg three times daily, Prazosin 2mg twice at night, synthetic thyroid hormone 125 mcg daily, Trokendi XR 50mg daily, Glipizide XL 10mg daily, Duloxetine HCL 60mg daily, Vitamin B12 1000mcg daily, Vitamin D3 25mcg twice daily, Fish Oil 1200mg twice daily, Trazodone 50mg twice at night, and Vraylar 10mg daily. The patient has noticed a strong yeasty smell in her urine for over a month, along with abdominal cramping and light bleeding. She vomits about once a week. Her last menstrual period was at the beginning of last month, and she has observed changes in her menstrual cycle, which she attributes to taking the Depo injection.

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Arora's Assessment

What might be happening

Based on the information you’ve provided, there are several serious conditions that could be contributing to your symptoms:

  1. Diabetic Ketoacidosis (DKA): Given your high blood sugar level (586 mg/dL), nausea, frequent urination, and severe lightheadedness, you might be experiencing DKA. This is a serious complication of diabetes that occurs when your body starts breaking down fats too quickly, leading to a buildup of acids in the bloodstream. Typical treatments include intravenous fluids, insulin therapy, and electrolyte replacement.

  2. Hyperglycemic Hyperosmolar State (HHS): This is another severe complication of diabetes characterized by extremely high blood sugar levels, severe dehydration, and altered consciousness. It requires immediate medical attention and is treated with fluids, electrolytes, and insulin.

  3. Urinary Tract Infection (UTI): The strong yeasty smell in your urine and frequent urination could indicate a UTI, which can be more common in people with diabetes. UTIs are typically treated with antibiotics.

  4. Electrolyte Imbalance: Severe lightheadedness and cramping could also be due to an imbalance in your electrolytes, which can occur with high blood sugar levels and dehydration. This would require blood tests and appropriate electrolyte replacement.

  5. Pancreatic Issues: Given your history of bowel inflammation and pancreas issues, there could be an underlying pancreatic condition contributing to your symptoms. This would need further investigation through imaging and blood tests.

What you can do

  1. Seek Immediate Medical Attention: Given the severity of your symptoms and the potential for serious complications like DKA or HHS, you should seek immediate medical attention. Go to the nearest emergency room or call 911 if you feel too unwell to get there yourself.

  2. Monitor Blood Sugar Levels: Continue to monitor your blood sugar levels closely. If you have a ketone meter, check for ketones in your blood or urine.

  3. Stay Hydrated: Drink plenty of water to help manage your blood sugar levels and prevent dehydration. However, avoid sugary drinks.

  4. Medication Review: Bring a list of all your medications to the hospital so that healthcare providers can review them and make any necessary adjustments.

  5. Follow-Up Care: After receiving emergency care, follow up with your primary care physician or endocrinologist to manage your diabetes and any other underlying conditions.

Please remember, I am not a doctor. It is crucial to seek care from real health professionals to receive a formal diagnosis and appropriate treatment. If you are alone, feel light-headed, develop a headache, or feel that your symptoms are worsening, please call 911 immediately.

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4 mo ago

People Also Ask


What are the symptoms of Diabetic Ketoacidosis (DKA) and how is it treated?

Symptoms of Diabetic Ketoacidosis (DKA) include high blood sugar levels, nausea, vomiting, abdominal pain, frequent urination, and severe lightheadedness. It is treated with intravenous fluids, insulin therapy, and electrolyte replacement.


How can high blood sugar levels lead to severe dehydration and what is Hyperglycemic Hyperosmolar State (HHS)?

High blood sugar levels can cause the body to lose fluids and electrolytes, leading to severe dehydration. Hyperglycemic Hyperosmolar State (HHS) is a condition characterized by extremely high blood sugar levels, severe dehydration, and altered consciousness. It requires immediate medical attention and is treated with fluids, electrolytes, and insulin.


What are the common signs of a Urinary Tract Infection (UTI) and how is it treated?

Common signs of a Urinary Tract Infection (UTI) include a strong smell in the urine, frequent urination, and abdominal cramping. UTIs are typically treated with antibiotics.


How can electrolyte imbalances affect the body and what are the symptoms?

Electrolyte imbalances can cause symptoms such as severe lightheadedness, cramping, and fatigue. They occur when the levels of electrolytes in the body are too high or too low, often due to dehydration or high blood sugar levels. Treatment involves blood tests and appropriate electrolyte replacement.


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