Why was this patient in metabolic acidosis

Reference no: EM133629364

Assignment

Textbook: Pagana: Mosby's Manual of Diagnostic and Laboratory Tests, 6th Edition Adolescent With Diabetes Mellitus (DM)

Case Study: Adolescent With Diabetes Mellitus (DM)

The patient, a 16-year-old high-school football player, was brought to the emergency room in a coma. His mother said that during the past month he had lost 12 pounds and experienced excessive thirst associated with voluminous urination that often required voiding several times during the night. There was a strong family history of diabetes mellitus (DM). The results of physical examination were essentially negative except for sinus tachycardia and Kussmaul respirations.

Studies	Results
Serum glucose test (on admission), p. 227	1100 mg/dL (normal: 60-120 mg/dL)
Arterial blood gases (ABGs) test (on admission), p. 98
pH	7.23 (normal: 7.35-7.45)
PCO2	30 mm Hg (normal: 35-45 mm Hg)
HCO2	12 mEq/L (normal: 22-26 mEq/L)
Serum osmolality test, p. 339	440 mOsm/kg (normal: 275-300 mOsm/kg)
Serum glucose test, p. 227	250 mg/dL (normal: 70-115 mg/dL)
2-hour postprandial glucose test (2-hour PPG), p. 230	500 mg/dL (normal: <140 mg/dL)
Glucose tolerance test (GTT), p. 234
Fasting blood glucose	150 mg/dL (normal: 70-115 mg/dL)
30 minutes	300 mg/dL (normal: <200 mg/dL)
1 hour	325 mg/dL (normal: <200 mg/dL)
2 hours	390 mg/dL (normal: <140 mg/dL)
3 hours	300 mg/dL (normal: 70-115 mg/dL)
4 hours	260 mg/dL (normal: 70-115 mg/dL)
Glycosylated hemoglobin, p. 238	9% (normal: <7%)
Diabetes mellitus autoantibody panel, p. 186
insulin autoantibody	Positive titer >1/80
islet cell antibody	Positive titer >1/120
glutamic acid decarboxylase antibody	Positive titer >1/60
Microalbumin, p. 872	<20 mg/L

Diagnostic Analysis

The patient's symptoms and diagnostic studies were classic for hyperglycemic ketoacidosis associated with DM. The glycosylated hemoglobin showed that he had been hyperglycemic over the last several months. The results of his arterial blood gases (ABGs) test on admission indicated metabolic acidosis with some respiratory compensation. He was treated in the emergency room with IV regular insulin and IV fluids; however, before he received any insulin levels, insulin antibodies were obtained and were positive, indicating a degree of insulin resistance. His microalbumin was normal, indicating no evidence of diabetic renal disease, often a late complication of diabetes.

During the first 72 hours of hospitalization, the patient was monitored with frequent serum glucose determinations. Insulin was administered according to the results of these studies. His condition was eventually stabilized on 40 units of Humulin N insulin daily. He was converted to an insulin pump and did very well with that. Comprehensive patient instruction regarding self-blood glucose monitoring, insulin administration, diet, exercise, foot care, and recognition of the signs and symptoms of hyperglycemia and hypoglycemia was given.

Task

Question A. Why was this patient in metabolic acidosis?

Question B. Do you think the patient will eventually be switched to an oral hypoglycemic agent?

Question C. How would you anticipate this life changing diagnosis is going to affect your patient according to his age and sex?

Question D. The parents of your patient seem to be confused and not knowing what to do with this diagnoses. What would you recommend to them?

Reference no: EM133629364

Questions Cloud

How could it be made more generalizable to broader public : How could it be made more generalizable to the broader public? Some suggested technologies include the use of nanotechnology, telemedicine.

What is the state of deposits with scbs : What is BSR 1 and 2 and What is the state of Deposits with SCBs? 3.Is the mix of short and long-term deposit changing

What will happen if a recession reduces fan income : Show what will happen if a recession reduces fan income in the large market. Briefly summarize and explain the impact on the equilibrium winning percentage

Which is greater than zero, when the level of output is zero : must be decreasing when the level of output is zero. will be equal to fixed cost, which is greater than zero, when the level of output is zero

Why was this patient in metabolic acidosis : Why was this patient in metabolic acidosis? How would you anticipate this life changing diagnosis is going to affect your patient according to his age and sex?

What payouts to mickey would be most consistent : what payouts to Mickey would be most consistent with the findings of behavioral economists?

Have you incorporated of strategies into breakfast routine : What have you noticed about your energy level during activity and throughout the day? What has become your "go to" breakfast?

What are some shifts in the dvd rental service industry : What are some Shifts in the dvd rental service industry's supply and demand

What has primarily contributed to irans economic challenges : What has primarily contributed to Iran's economic challenges, including a significant loss of oil revenues and foreign investment?

User Account

All Pages