Case I Type I Diabetes and Acidosis Samantha Styles is a 30-year-old woman who i
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Case I Type I Diabetes and Acidosis Samantha Styles is a 30-year-old woman who is suffering from Type I Diabetes Mellitus. She takes insulin shots on a regular basis to keep her blood glucose and body energy levels in check. One day Samantha took an afternoon nap and stayed asleep for longer than usual. Her room-mates tried to wake her up but she did not respond. She was immediately taken to the emergency room of a hospital where she was declared to be in a state of coma. Her room-mates reported that Samantha had been feeling nauseated and drowsy and had been vomiting intermittently during the last 24 hours. Samantha is clinically dehydrated, and her blood pressure is low. Her respirations are deep and rapid and her pulse rate is rapid too. Her breath has the "fruity" odor to it. Subsequent blood analyses were done to investigate her arterial blood pH, arterial partial pressure of carbon dioxide (Pco2), serum glucose, and serum bicarbonate (HCO3) levels. The blood work revealed that her blood pH is 7.08 (reference range 7.38 to 7.42), and that ketone bodies are present in both her blood and urine. Her blood glucose level is 648 mg/dL (reference range -80 to 100 mg/dL after an overnight fast, and no higher than 200 mg/dL in a casual glucose sample taken without regard to the time of a last meal). In addition, HCO3 ion levels are below 21 meq/ml. Questions 1. What is Samantha Styles suffering from and describe how does Type I 2. Describe the three main causes associated with metabolic acidosis and 3. Why is Samantha suffering from clinical dehydration and coma? Explain the 4. Describe the compensatory mechanisms involved in overcoming metabolic 5. One of the effects of insulin is to stimulate production of lipoprotein lipase Diabetes Mellitus result in the development of this disease state? discuss how they can lead to metabolic acidosis? reason for this symptom. acidosis (LPL). What is the function of lipoprotein lipase and state the effect of its decreased activity on Ms. Styles? 6. How does a lack of insulin affect glycogen metabolism? Which major enzyme/s in glycogen metabolism is affected by lack of insulin?Explanation / Answer
1) The Condition developed is Diabetic Ketoacidosis. It is life threatening condition where the body is unable to get glucose into the cells because of lack of insulin. The glucose thus remains in the body unabsorbed and the kidney works on to remove some of the glucose molecules in the urine. Due to disturb metabolism, fat starts metabolized releasing ketones in the body.
Diabetic Ketoacidosis represent symptoms like dehydration, fruity smell in urine, high blood sugar levels, lack of appetite, vomiting, dry or flushed skin, rapid and speedy breathing, drowsiness and confusion. And many of the symptoms are presented by Ms.Samantha Styles. Therefore this condition is Diabetic Ketoacidosis.
Excess accumulation of glucose in the cells due to lack of absorption in to the body as a result of no insulin or lack of insulin production. Moreover infection, injury or missed insulin shots or improper insulin management can result in diabetic ketoacidosis. In type 1 diabetes the cells of pancreas is already impaired which produces no or less insulin, however, when such things are uncontrolled with improper insulin management, the body has lack of glucose to use as fuel. In such instances, fat metabolism gets initiated resulting in ketones release into blood stream which is filtered through kidneys to prevent from intoxication of ketones.
2) Metabolic acidosis results from disturbed acid base balance in the blood. It results from increased production of acid or improper balancing of acid molecule or poor base production to neutralise normal acid secretion.
There are different causes towards metabolic acidosis which are Ketoacidosis, Lactic acidosis, Renal Tubular Acidosis and hyper chloremic acidosis.
Ketoacidosis- in this condition, enough glucose molecules are not available in the cells for energy resulting in fat metabolism.. Fats are burnt into ketones which are released in the blood stream causing dehydration, fruity urine smell. These ketones in the blood turns into acidic resulting in metabolic acidosis
Lactic acidosis- When the body have unavailability of oxygen molecules to use may be due to causes like heart failure, respiratory failure, hypotension, septicemia resulting in lactic acid release from the muscles. Accumulation of lactic acid turns the blood an acidic media causing Metabolic acidosis.
Renal tubular acidosis- any diseases of kidneys can result in dysfunction in filtration process. Kidneys plays a vital role in maintaining acid base balance by filtering the molecules out of the body or into blood stream for further mechanism. If this process gets interrupted which might result in stagnation of acid molecules causing Metabolic acidosis.
Hyper chloremic Acidosis- conditions like severe diarrhea, laxative abuse and kidney diseases can result in decrease in bicarbonate production. Bicarbonate is the neutralising agent for the acid. Decrease in this levels can make the blood more acidic causing Metabolic acidosis.
3) Clinical dehydration is due to the presence of ketones in the blood stream as a by product of fat metabolism to obtain energy. She is in a state of ketoacidosis with 648 mg/dL ,this indicates that the insulin shots are enough for the control of glucose levels. Moreover, she had bouts of vomiting within a period of. 24hrs which can also leads to dehydration and disturbance in acid base balance in the body.
Coma is due to the uncontrolled blood glucose levels, presence of ketones in urines, dehydration and vomiting. These are caused because of Diabetic Ketoacidosis.
4) To compensate metabolic acidosis there are different mechanisms in the body.
The respiration gets increased to throw away the carbon dioxide decreasing the level of acid in the blood.The central chemoreceptors gets activated when there is decreased blood pH increasing the drive to breathe faster.
Intracellular compensation by absorbing hydrogen molecules as much as possible from proteins , phosphate and carbonate in bone to produce bicarb and neutralize the acid.
Renal compensation by incresing the filtration of acids and increasing the base levels into bloodstream.
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