Age: 19.0
Sex: F
Vaccine: COVID19
Symptoms: Anion gap, Antibody test, Blood bicarbonate decreased, Blood glucose increased, Blood ketone body
Clinical narrative: In summary, patient is a 19-year-old with new onset diabetes.  She has hyperglycemia without acidosis.  She has received her first dose of subcu insulin.  She understands her diagnosis.  She is eager to be able to go home but understands the need to be admitted for education.  In discussions with the family, family is concerned that diabetes is from her Pfizer Covid vaccine which she received in August.  I have discussed this with pharmacist.  That time.  Is quite long to be a side effect.  Additionally endocrinopathies have not been previously described.  The family is reassured that we are taking that concern seriously.  They also understand that this is unlikely to be related to the vaccine.  As per attending admission policy, endocrine fellow spoke to accepting attending.  Patient transferred to inpatient unit for education and diabetes management.  Admission HPI: Patient is a healthy 19F with PMH of vasovagal syncope, eczema and allergic rhinitis who presented to the ED with 4 weeks of polydipsia and polyuria.     Patient is a student and began noticing that she had a dry mouth and was excessively thirsty a few weeks ago. She jokingly said she had diabetes but did not think much of it. She also noticed she was urinating more frequently, waking up in the middle of the night to drink and void. She has also had a 10lb weight loss over the last few months. Denies any abdominal pain or nausea/vomiting or other preceding infection or illness during this period.      She is home this weekend visiting her parents, and noticed she was drinking gallons of water, so she wanted to have this evaluated, so she went to her pediatrician where she had an elevated blood sugar level and was referred to  ED for further evaluation.     In the ED, she was HDS, mildly tachycardic with a well-appearing with an exam notable for non-tender abdomen. Labs were notable for glucose 319, BOHB 4.45, pH 7.35/41.9, bicarb 20, AG 17, and HbA1c 12.4%. Reassuringly, her kidney function was normal. She was diagnosed with new-onset diabetes, but was reassuringly not in DKA. Endocrine was consulted and she was initiated on a subcutaneous insulin regimen and admitted for further management.   Confidential social history:   - Sexually active, uses protection and is on birth control. Has her period currently.  - Uses alcohol and tobacco socially, no recreational drug use  - Feels safe at home and school  Hospital Course: Patient was admitted to the endocrine team with diabetes mellitus.   The patient presented with several weeks of polyuria, polydipsia, and weight loss. The blood glucose level on arrival to the ED was 319 mg/dL.  Initial laboratory evaluation included bicarbonate 20 mEq/, anion gap 17 mEq/L, venous pH 7.35, and ketonuria. Hemoglobin A1c was 12.4%.  This presentation was diagnostic of diabetes mellitus.   Given a history of elevated BMI, a gradual onset of symptoms, a diagnosis of type 2 diabetes was considered most likely. Confirmatory antibody testing is pending.   Patient was initiated on a basal-bolus insulin regimen with Lantus and Humalog. The insulin regimen was adjusted to achieve adequate glycemic control prior to discharge. Final insulin regimen is in the patient instruction section of the discharge summary.   Family education was provided by diabetic nurse educators and nutritionists regarding basic concepts and skills for diabetes management.  At the time of discharge, parent(s)/primary caregiver(s) demonstrated understanding of these concepts and adequate technical skills for safe diabetes management until the follow-up visit. Following discharge, patient and family will follow up with Endocrinology team at Hospital.