Case Study 53 Diabetes Mellitus Type 1 PDF

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Case Study 53 - Diabetes Mellitus, Type 1 1) “Some people I know with diabetes can take pills,” says S.C. “Why can’t I take pills instead of having to take insulin?” she asks. What is an appropriate response to her question? An appropriate response to S.C’s question would be, “People with type 1 diabetes cannot take pills because they are not as fast acting as insulin shots. Making it harder to regulate too. Additionally, the diabetes pills only work on existing cells that already create insulin and make them release more. But in your case, S.C, you are not making insulin at all, so you must take insulin shots.” 2) What is the single greatest risk factor for type 1 diabetes mellitus that this patient has? The patient's single greatest risk factor for type 1 diabetes is her older brothers diagnosis of type 1 diabetes at the age of 10. The patient’s grandmother also died at age 50 from renal complications of type 1 DM. 3) What causes heavy breathing in a patient with type 1 diabetes mellitus? Heavy breathing in patients with type 1 diabetes mellitus is caused by ketoacidosis. Ketones are acidic and accumulate in the blood leading to low pH blood levels. In order to raise the blood pH, the patient will breathe heavily and hyperventilate exhaling CO2. 4) What is this type of breathing called? This type of breathing is called Kussmaul Respirations.

5) Why is it appropriate for the physician to inquire about fever, chills, diarrhea, cough, sore throat, and painful urination? It is appropriate for the physician to inquire about fever, chills, diarrhea, cough, sore throat, and painful urination in order to see if there are any more complications such as an infection.

6) Distinguish between paresthesias, dysesthesias, and anesthesias. Paresthesias is abnormal sensation such as numbness and tingling. Dysethesias is an abnormal sense of touch that can be painful. Lastly, anesthesias is total or partial loss of the sense of touch. 7) Describe the pathophysiology of paresthesias, dysesthesias, anesthesias. Paresthesias comes from nerve and blood vessel damage caused by excessively high glucose levels over a period of time. Dysesthesias is caused by nerve damage resulting in incorrect signaling. Anesthesia can be caused by a nerve injury or disease. 8) Which types of endocrine disorders are characterized by heat and cold intolerance? The types of endocrine disorders characterized by heat and cold intolerance are thyroid disorders (hyperthyroidism and hypothyroidism). A very common one is Grave’s disease. 9) Is this patient technically underwieght, overwigth, obese, or is the patient’s weight healthy and normal? The patient is at a normal body weight. Typical weights for 13 year old girls ranges from 82 to 137 lbs. The patient is at 87lbs. Additionally, her BMI is 17. When placed on the BMI-for-age, she lands on the 24th percentile for girls ages 13 which is within normal ranges. 10) Identify three signs that suggest this patient is dehydrated. Three signs that suggest this patient is dehydrated include her pale and dry skin with moderately decreased turgor and dry mucous membranes. The vomiting and diarrhea that the patient has been experiencing may have led to severe fluid loss and dehydration as well.

11) Are “downgoing plantars” a normal or abnormal neurologic response? “Downgoing plantars” are a normal neurological response. 12) Identify four laboratory test results that are consistent with a diagnosis of diabetic ketoacidosis.

Four laboratory test results that are consistent with a diagnosis of diabetic ketoacidosis include acetone levels of 3+, glucose of 554 mg/dL, HCO3 levels are below normal at 15 meq/L, and the anion gap which displays an abnormally high value at 20.1 meq/L. Normal values for anion gap consists of 6-12 meq/L. 13) How was anion gap determined in this patient? Anion gap was determined in this patient by looking at the difference between cation measurements (Na+ and K+) and anion measurements (Cl and HCO3). 14) Identify three laboratory test results that are consistent with a diagnosis of dehydration. Three laboratory test results that are consistent with a diagnosis of dehydration would include the patient’s high BUN value at 23 mg/dL. Normal BUN values are 8-20 mg/dL. Cr values are also high at 1.5 mg/dL. Normal values for Cr are 0.6-1.2 mg/dL. The patient's electrolytes are also abnormal indicating dehydration. The patient’s sodium value is low at 127 meq/L along with an abnormally high potassium value at 6.1 meq/L. The patient’s chloride is also low at 98 meq/L. 15) What has probably caused this patient’s abnormal plasma sodium and chloride concentrations? This patient’s abnormal plasma sodium and chloride concentrations were probably due to illness. Including the vomiting and diarrhea that the patient has been experiencing for the past few days along with food-fluid intolerance. 16) Why is this patient’s serum potassium concentration abnormal? This patient’s serum potassium concentration is abnormal because H+ ions are going into the cells and kicking out potassium into the bloodstream due to the patient's acidosis. Also called hyperkalemic. 17) Why is this patient’s blood pH abnormal? This patient's blood pH is abnormal because of the ketones that are accumulating in her blood. Ketones are acidic thus lowering her pH values to an abnormal range.

18) Explain the pathophysiology of this patient’s low PaCO2. This patient's low PaCO2 levels are caused by hyperventilation. In order to raise her blood pH, that has been lowered due to the acidity in her blood, the patient does kussmaul respirations exhaling CO2. 19) What is the single major precipitating factor for this patient’s ketoacidosis? The single major precipitating factor for this patient's ketoacidosis is her illness. This illness is affecting her glucose levels and usage leading to the development of ketoacidosis. 20) Provide seven clinical manifestations for your answer to question 19 above. Seven clinical manifestations would include the patient’s low Na+, high K+, low Cl, high BUN and Cr, high glucose, low pH, and low HCO3. 21) How is ketoacidosis most effectively managed? Ketoacidosis is most effectively managed by insulin therapy along with fluid and electrolyte replacement. Correcting acid-base imbalances, treating any illness present, and carefully monitoring sugar levels are other ways ketoacidosis may be effectively managed....