A 60-year-old man is found comatose by his relatives. Paramedics notice on physical examination that he has decreased skin turgor and dry mucous membranes. On arrival at the hospital, laboratory studies show blood glucose of 698 mg/dL, but no ketones in blood. Urine analysis is negative for ketone bodies and protein, but positive for glucose (4+). Which of the following is the most likely diagnosis?

Islet cell tumor secreting glucagon

Type 1 diabetes mellitus

Cushing syndrome

Type 2 diabetes mellitus Il 5

Answer: The most likely diagnosis is Type 2 diabetes mellitus.

Explanation:

Diabetes mellitus (DM) is a metabolic disorder which occurs due to relative or chronic insulin insufficiency (resulting from either insulin resistance or failure to produce insulin) leading to excessive sugar in the blood (hyperglycemia). There are two major forms of diabetes mellitus: Type 1 and Type 2 DM.

Generally, polyuria (excess urination) is a common symptom seen in both types of DM. Due to excess sugar in the blood stream the kidney lowers the blood glucose by filtering out excess glucose alongside with this, water is filtered out too. This can lead to dehydration (decreased skin turgor and dry mucous membranes) if not properly handled.

In Type 1 DM, it has an early onset and in its Laboratory diagnosis, there is usually ketones in both blood and urine.

In Type 2 DM, it usually occurs in older individual. Hyperglycemic, hyperosmolar, nonketotic diabetic coma occurs only in Type 2 diabetes mellitus.

Type 2 diabetes mellitus Il 5

Explanation:

Type 2 diabeties mellitus is a clinical presentation that is associated with hyperglycemic, hyperosmolar, nonkekotic coma. It is often common in older person, from age 40 and above. One of the symptoms is dry mouth.

Diagonistic criteria includes:

A random plasma glucose of 200 mg/dL (11.1 mmol/L) or higher in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis.

Hence, in this case, the man is above 40 years old, the blood glucose is above 200mg/DL, has a dry mouth and urine analysis is negative for ketone bodies and protein, all these are diagnostic criteria in a Type 2 diabeties mellitus 5.