OET Writing practice · Medicine
Discharge after diabetic ketoacidosis – new GP
An original practice task written by LetterScore AI. Read the case notes in 5 minutes, then write your discharge letter in 40 minutes, about 180–200 words in the body.
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Case notes
MEDICINE — WRITING TASK (practice) Time allowed: Reading time 5 minutes, Writing time 40 minutes Read the case notes below and complete the writing task which follows. Notes: Today's date: 02/09/2026 You are a junior doctor on the Acute Medical Unit, St Brigid's University Hospital, Kilmore. Patient: Ms Aoife Brennan, DOB 19/04/2004 (22 yrs) Admission date: 30/08/2026 Discharge date: 02/09/2026 Social background: - 2nd-year architecture student. Moved into shared flat early 08/2026; registered with new GP 01/08/2026 - Works in café at weekends. Parents live 200 km away - Non-smoker. Alcohol 10–14 units/week, occasional binge drinking Medical history: - Type 1 diabetes mellitus, dx 2018 (age 14); one previous DKA admission 2021 - Childhood asthma, resolved - Acne, topical treatment Medications on admission: - Insulin glargine 18 units SC nocte - Insulin aspart SC with meals (1 unit per 10 g carbohydrate) - Combined oral contraceptive pill - NKDA Clinical notes: 30/08 ED: 2 days vomiting, diarrhoea, abdominal pain, thirst, polyuria. Flatmates also unwell. Stopped aspart because "not eating". Missed several glargine doses over past 10 days – ran out of pen needles; repeat prescription not yet transferred to new GP. O/E: drowsy, GCS 14, Kussmaul breathing, dry mucous membranes. HR 124, BP 96/58, T 37.4°C. Abdomen soft, diffusely tender. Ix: capillary glucose 26.4 mmol/L, blood ketones 5.8 mmol/L, venous pH 7.08, bicarbonate 8 mmol/L, K+ 5.6 mmol/L, Na+ 131 mmol/L, creatinine 104 µmol/L. Amylase normal. Pregnancy test negative. ECG: sinus tachycardia. Tx: DKA protocol – IV fluids, fixed-rate IV insulin infusion, potassium replacement; glargine continued. 31/08 DKA resolved after 14 hrs (ketones 0.4 mmol/L, pH 7.34). K+ 3.9 mmol/L. Eating and drinking; SC basal-bolus insulin restarted. Stool PCR: norovirus positive. HbA1c 86 mmol/mol (March 2026: 71). 01/09 Diabetes specialist nurse (DSN) review: good carbohydrate-counting knowledge; unaware of sick-day rules; no blood ketone meter at home. Ketone meter supplied; sick-day rules taught. Pt admits often skipping mealtime insulin when out with friends. Reports low mood since moving, poor sleep, feeling isolated. PHQ-9 score 13 (moderate). Denies thoughts of self-harm. Would like support. Asks about switching to a different contraceptive – advised to discuss with GP. 02/09 Glucose 6–12 mmol/L. Diarrhoea settled. Observations normal. Mild acne flare. Medications on discharge: - Insulin glargine 20 units SC nocte (increased) - Insulin aspart 1 unit per 10 g carbohydrate with meals - Combined oral contraceptive pill - Blood glucose and ketone test strips Plan: - GP to set up repeat prescriptions urgently: insulins, pen needles, glucose and ketone strips - GP review of mood within 2 weeks; consider referral to psychological therapies or student counselling - DSN telephone follow-up in 1 week - Diabetes clinic (Dr Farouk) in 6 weeks - Advice given on alcohol and hypoglycaemia Writing Task: Using the information in the case notes, write a letter to Dr Clare Mulligan, General Practitioner, Riverbank Medical Centre, 14 Quay Street, Kilmore, who has recently registered Ms Brennan as a patient. In your answer: - Expand the relevant notes into complete sentences - Do not use note form - Use letter format The body of the letter should be approximately 180–200 words.
How to approach this discharge letter
- The reader takes over care after discharge. Open with who the patient is, why they were in hospital and that they are going home, then say what you need the reader to do.
- Give the current condition, medication changes and the follow-up plan. Summarise the hospital stay instead of retelling it day by day.
- Leave out resolved problems and background that does not change care at home.
Members also get the model answer, the note-selection table and task-specific tips for this task.