Case #1 A fifteen year old boy with insulin-dependent diabetes mellitus is broug
ID: 271790 • Letter: C
Question
Case #1 A fifteen year old boy with insulin-dependent diabetes mellitus is brought to the ER by his father because of severe abdominal pain and vomiting for the past six hours. The father says that he has been complaining of mild stomach "cramps" and "thirst" for the past few days, but nothing this extreme. When the father leaves the room, the boy reluctantly admits that he has not been taking his insulin because he is mad at his parents for going away on a cruise and "leaving him" for five days. His blood pressure is 100/70 mmHg, pulse is 98/min, and respirations are 30/min. Physical examination shows dry skin and mucus membranes and diffuse abdominal pain. Laboratory studies show Glucose: 675 mg/dL Potassium: 6.0 mEq/L Bicarbonate: 11 mEq/L " Sodium: 136 mEq/L Chloride: 89 mEq/L For this patient, what is the most likely diagnosis? List the three types of diabetes and discuss the pathogenesis, treatment, and long-term sequelea for each type.Explanation / Answer
1. The most likely diagnosis would be Diabetic Ketoacidosis. Since, the boy is already diagnosed with Insulin Dependent Diabetes (Type I), there is insulin deficiency due to his condition and should have been prescribed with insulin daily. Since his parents left him for five days, the boy did not take his insulin medication which would have resulted from the condition
What happened in the body? As the boy is suffering from Diabetes mellitus (Type 1) glucose cannot be utilized in the cells as there is no insulin for promoting glucose utilization. Energy deprived cells utilize fat for energy whose metabolism results in production of ketone bodies (acetone, acetoacetate, betahydroxy butyrate) causing acidic urine. High levels of ketones result in abnormal function of enzymes, affected levels of electrolytes.
Glucose: 675 mg/dL (Normal range: 80-120)
Sodium: 136 mEq/L (Normal range: 133-145)
Potassium: 6 mEq/L (Normal range: 3.5-5.0)
Bicarbonate: 11 mEq/L (Normal range: 23.1-26.7)
Since, ketones are high in blood it results in osmotic diuresis that led to water loss, electrolyte imbalances as shown above. Due to lack of insulin therapy for 5 days, it resulted in Hyperglycemia. Acidosis led to the stomach pain and vomiting.
From the above findings, it is clear that the condition is Diabetic ketoacidosis
2. Three types of Diabetes are: Type 1, 2 and Gestational diabetes.
Type 1 - Insulin Dependent Diabetes mellitus:
Pathogenesis: Genetic susceptibility, loss of immunological self tolerance, abnormalitites in immune regulation and environment triggers result in destruction of Beta cells of islets of langerhans of pancreas reducing the production of Insulin. This leads to insulin deficiency
Treatment: Treatment include providing insulin (Insulin therapy) preparations to counter the deficiency of insulin and promote the glucose utilization
Long term effects: Atherosclerosis, Risk of Coronary artery disease, cerebro vascular complications, retinopathy, nephropathy, reduced wound healing, pyschological and emotional alterations etc
Type 2- Non insulin Dependent Diabetes mellitus:
Pathogenesis: Genetical defects leading to insulin resistance (even though there is normal production of insulin in the body unlike Type I), Decreased beta cell function, increased hepatic glucose production
Treatment: Treatment with Biguanides, sulfonylureas, thiazolidinediones, (Dipeptidyl peptidase)DPP4 inhibitors, (Glucose dependent insulinotropic peptide)GLP 1 receptor agonists or complex insulin strategy
Long term effects: Atherosclerosis, Risk of Coronary artery disease, cerebro vascular complications, retinopathy, nephropathy, reduced wound healing, pyschological and emotional alterations etc
Gestational Diabetes:
Pathogenesis: Gestational diabetes occurs in late in a woman's pregnancy. The hormones from the placenta prevent the action of insulin resulting in Insulin resistance and presenting symptoms of Diabetes similar to type II
Treatment: Can be controlled with Diet or Insulin depending upon the severity
Long term effects:
For the baby: Macrosomia, Delayed organ maturity, Organomegaly, metabolic hypoglycemia, seizures, irritability, hypomagnesemia, obesity, diabetes, impaired motor skills, increased risk of Attention Deficit/ Hyperactivity Disorder etc
For mother: cardiac, renal, opthalmic, peripheral vascular deterioration, gastroparesis, peripheral neuropathy
Related Questions
drjack9650@gmail.com
Navigate
Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.