Medical Emergencies · patient case question
What is this patient's ASA physical status classification?
Patient case: A Diabetic Who Does Not Check His Sugar
Patient: 56-year-old male
Chief Complaint: Broken tooth, wants it fixed.
Background: Type 2 diabetes for nine years. When asked about his blood glucose he says he does not test it and has not seen his physician in over a year. Reports increasing thirst and getting up at night to urinate.
Medications: Metformin — admits he is inconsistent with it
Vital Signs: BP 138/86 mmHg · HR 82 bpm · RR 16 · T 98.6°F
Findings: Generalized gingival inflammation with bleeding on probing, multiple 5–6 mm pockets, dry mucosa, and a fractured cusp on #14.
Show answer and explanation
Correct answer: C. ASA III
- A. ASA I is a healthy patient with no systemic disease and no smoking or significant alcohol use.
- B. ASA IV is severe systemic disease that is a CONSTANT THREAT TO LIFE — recent myocardial infarction or stroke within three months, unstable angina, an ejection fraction under 40%, or end-stage renal disease on dialysis.
- C. CORRECT. ASA III is severe systemic disease that is not incapacitating — and that is exactly what UNCONTROLLED or unmonitored diabetes represents. He does not know his glucose, he is inconsistent with his medication, and he has symptoms of hyperglycaemia. Contrast this with a patient whose type 2 diabetes is well controlled on stable medication with a documented HbA1c: that patient is ASA II.
- D. ASA II is mild systemic disease that is WELL CONTROLLED — controlled hypertension, controlled diabetes, controlled asthma, pregnancy, obesity with BMI 30–40, or being a current smoker.
Note: The single word that shifts a chronic disease from ASA II to ASA III is CONTROLLED versus UNCONTROLLED. It applies identically to diabetes, hypertension, asthma and epilepsy.
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