A 29-year-old woman with a history of insulin-dependent diabetes mellitus

A 29-year-old woman with a history of insulin-dependent diabetes mellitus was treated for a urinary tract infection. Twelve days later, she presented with persistent flank pain. Physical exam showed: She was a moderately ill-appearing woman who was afebrile with a heart rate of 140, respiratory rate of 32, and BP of 98/50. She did not appear to be dehydrated. There was costo-vertebral angle tenderness on the left and left lower quadrant (abdominal) tenderness with guarding, but without rebound tenderness. Laboratory Results: WBCs: 12,700/ul Neutrophils 70% Bands 12% Sodium: 127meq/l Potassium: 5meq/l Chloride: 92 Bicarbonate: 17 Glucose: 640mg/dl BUN: 32 Creatinine: 1.6 Urinalysis: Appearance: pink/cloudy Glucose: 2+ Ketones: 1+ Protein: 3+ Sediment Many RBCs Rare Bacteria 25 WBC/HPF Please answer the following questions: 1. What does her urinalysis indicate is going on with her? Please justify your answer. (2 points) 2. What is your explanation for her BUN of 32? Is it her kidneys? (2 points) 3. Explain her serum sodium in terms of serum osmolality (please be specific in your rationale). (3 points) 4. What is her acid-base status? (2 points) APA Format for citation/references (1 point)

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