Final answer:
A 30-year-old female with polyuria, polydipsia, and a blood glucose level of 650 mg/dl is likely experiencing Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS), distinguished by the absence of severe acidosis. Treatment includes the administration of fluids and insulin.
Step-by-step explanation:
The patient, a 30-year-old female, presents with symptoms of polyuria and polydipsia, indicative of diabetes. The significantly elevated blood glucose level of 650 mg/dl, coupled with a slightly low bicarbonate level (21) and normal pH (7.35), points towards a diagnosis of Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS), which often presents without severe acidosis, unlike diabetic ketoacidosis (DKA), where the pH would be considerably lower. The pathophysiology involves stress leading to increased cortisol, which in turn increases blood glucose levels.
Treatment for HHNS includes rehydration with fluids to counteract dehydration and insulin therapy to lower the blood glucose levels. In terms of electrolyte balance, sodium (Na) is usually low due to hyperosmolar hyponatremia, while potassium (K) levels may be variable and require monitoring and adjustment to avoid hypokalemia or hyperkalemia, consequences of the insulin therapy and fluid replacement. Close monitoring and corrective treatment of the Na and K balances are crucial components of the management of HHNS.