Assignment task: A 36-year-old Hispanic woman presents to the emergency department for evaluation and management of refractory nausea, vomiting, and abdominal pain. Symptoms have persisted for 2 days, and the patient has felt somewhat short of breath and light-headed when standing for the past 12 hours. She is recently divorced and could not find someone to care for her child until today. She was diagnosed with gestational diabetes mellitus 3 years ago and then type 2 diabetes when hyperglycemia persisted after delivery. The patient's only medication is metformin. Examination is notable for resting tachycardia, mild tachypnea, dry mucous membranes, and modest, diffuse pain on palpation of the abdomen. Capillary blood glucose (CBG) is >500 mg/dL. Initial electrolyte panel revealed sodium 132 mEq/L, potassium 4.6 mEq/L, chloride 92 mEq/L, bicarbonate 12 mEq/L, blood urea nitrogen (BUN) 20 mg/dL, creatinine (Cr) 0.7 mg/dL, and glucose 520 mg/dL. Anion gap was computed to be 28. Arterial blood gas was notable for pH 7.21, pCO2 34 mm Hg, pO2 80 mm Hg, and calculated bicarbonate 14 mEq/L. Need Online Tutoring?