MedEdPORTAL (Feb 2015)
A PBL Case of a 59-Year-Old Diabetic Woman with Severe Lactic Acidosis
Abstract
Abstract Introduction There is a high and rising prevalence of Type 2 diabetes in the US, as well as an increasingly common use of metformin to aid in glucose control. When a patient does not respond well to metformin, practitioners must be able to integrate their basic and clinical science knowledge to understand the cause and determine the solution. Methods This problem-based learning (PBL) case involves a mistake in the management of a diabetic patient with renal failure who was prescribed metformin, causing rapid and severe lactic acidosis that was successfully resolved, although nearly fatal. It is based upon an actual case treated by one of the authors. The case was designed for facilitated, small groups of first-year medical students who were learning about the biochemistry of blood buffering, carbohydrate metabolism and diabetes, and the physiology of renal function. Because of the emphasis on learning the basic science underlying the patient's signs and symptoms, the case was facilitated by basic science and other non-physician PBL faculty, as well as basic science-oriented physicians, using progressive the disclosure approach over three 1.5-hour PBL sessions. Results Always receiving high marks from students and facilitators, the case has been successfully used in alternate years since its inception in the Fall of 1999, with very few changes resulting from continuous formative reviews. Discussion The prevalence of Type 2 diabetes and common use of metformin, make this case relevant and significant, while the medical mismanagement adds a noteworthy twist. Given the fact that this was the last of five Fall PBL cases and was presented after students learned carbohydrate metabolism and diabetes biochemistry, and the physiology of renal function, learners were well-prepared to achieve stated objectives. The case furthers the development of skills assessed in PBL including: use of knowledge base, knowledge acquisition and teaching, thinking and reasoning, and teamwork and communication.
Keywords
