Scenario
You are working in an outpatient clinic when a mother brings in her 20-year-old daughter, C.J., who has
type 1 diabetes mellitus (DM) and has just returned from a trip to Mexico. She has had a 3-day fever
and diarrhea with nausea and vomiting. She has been unable to eat and has tolerated only sips of fluid.
Because she was unable to eat, she did not take her insulin as directed. You note C.J. is unsteady, so you
take her to the examining room in a wheelchair. While assisting her onto the examination table, you note
her skin is warm and flushed. Her respirations are deep and rapid, and her breath is fruity and sweet smelling.
C.J. is drowsy and unable to answer your questions. Her mother states, “She keeps telling me she’s so
thirsty, but she can’t keep anything down
Scenario You are working in an outpatient clinic when a mother brings in her 20-
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