A 46-Year-Old Man Is Hospitalized with Diabetic Ketoacidosis

question 143

Multiple Choice

A 46-year-old man is hospitalized with diabetic ketoacidosis.  He is administered intravenous fluids and an insulin drip, and laboratory testing is ordered.  In the morning, the on-call physician hands off the patient to the day shift physician, who arrives an hour late due to an emergency at his nighttime moonlighting job.  The handoff information includes the status of the patient and instructions to check electrolytes and calculate his anion gap.  The physician performs inpatient rounds and then sees his usual clinic outpatients in the afternoon, but he neglects to check the patient's anion gap.  The patient subsequently develops worsening acidosis requiring intubation for respiratory distress.  Which of the following is the most likely cause of this adverse outcome?

• A)Deficiency of knowledge
• B)Excessive patient caseload
• C)Inadequate patient handoff
• D)Judgment error
• E)Physician burnout
• F)Physician fatigue

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Definitions:

Favorable Outcome

A result or end that is considered to be beneficial, positive, or desirable, often used in the context of therapy or intervention studies.

Archetypes

Universal, inherited models of people, behaviors, or personalities that play a role in influencing human behavior, as proposed by Carl Jung.

Consciousness

The state of being aware of and able to think about one's own existence, sensations, thoughts, surroundings, and experiences.

Influenced

The capacity of a person, object, or idea to have an effect on others or the environment, often without direct or physical presence.