2. Infectioustoxic shock

3. Hepatic coma

4. Diabetic ketoacidotic coma

5. Hyperosmolar coma

Case N 39. The unconscious woman of 25 years old is delivered to hospital. She is suffering from Diabetes Mellitus for the past 8 years. In the morning the patient could not wake. Objectively: The skin is dry, the turgor is reduced, eyeballs are mild. Kussmaul's respiration, the odor of acetone from the mouth. The pulse - 130 beats /minutes, the blood pressure - 100/65 mmHg. The liver is +2 cm. Lab studies: the glucose of blood - 25,5 mmol/L. The emergency treat­ment will consist of introduction:

A. Insulin of prolonged acting 10 U hourly i/v

2. 40% glucose solution i/v

3. Reopolyglukin up to 1,0 L i/v

4. 0,9% NaCl solution i/v

5. Rapid-acting insulin in the dose of 10 u hourly I/V

Case N 40. Patient X., 67 years old. Duration of type 2 Diabetes Mellitus during 9 years. Patient keeps to the prescribed diet, receives regular treatment with oral drugs, and several times in the few last years was treated by sulfonylureas with maximal therapeutic doses. What complication should you consider?

A. Hyperglycaemia

B. Hypoglycaemia

C. Diabetic ketoacidosis

D. Hyperosmolality

E. Lactic acidosis

Case N 41. Patient M., 67 years old. Duration of type 2 Diabetes Mellitus during 19 years. He treats by Metformin in a daily doses 1500 mg. In anamnesis – cardiovascular disease and chronic bronchitis. He has coma in investigation of pneumonia. Objectively: the skin is wet. Kussmaul's respiration. The pulse - 110 beats /minutes, the blood pressure - 110/70 mmHg. Lab studies: the glucose of blood - 12,5 mmol/L. The ketonemia and acetonuria are absent. Establish the correct diagnosis:

1. Hyperglycaemia

2. Hypoglycaemia

3. Diabetic ketoacidosis

4. Hyperosmolality

5. Lactic acidosis

Case N 42. Patient E., 72 years old, is suffering from type 2 diabetes mellitus during 23 years. She treats of biguanides (daily doses - 2 gram). On the second week of pneumonia she is hospitalized to the emergency department. Objectively: somnolence, the skin is wet. Kussmaul's respiration. Muscle tones are normal. Lab studies: the glucose of blood - 13,6 mmol/L. The ketonemia and acetonuria are absent. The emergency treat­ment will consist of introduction:

1. 40% glucose solution i/v

2. 50-100 ml 1 % methylene-blue solution and trisamine i/v

3. 0,45% NaCl solution i/v

4. Rapid-acting insulin in the dose of 10 IU hourly i/v

5. 2,5 % sodium bicarbonate solution 1-2 l/day i/v

Case N 43. The patient T., 50 years old, body height of 165 cm, weight of 78 kg, suffers from type 2 diabetes mellitus during 10 years. In connection with the decom­pensation of carbohydrate metabolism she is transferred to insulin, the daily dose - 60 IU. For last 5 months her weight has increased for 5 kg, night hypoglycemias are observed during this period. The fasting level of glucose of the capillary blood is 15,5 mmol/L. The cause of the decompensation of diabetes mellitus is: