case study A diabetes mellitus type . For questions 5-9z 425 CHAPTER 16 Endocrin
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case study A diabetes mellitus type . For questions 5-9z 425 CHAPTER 16 Endocrine System Disorders CASE STUDY A Diabetes Mellitus Type 1 Mr. M. h admitted to the hospital with severe pyelonephritis, a kidney as had Type 1 diabetes for 15 years. He has just been infection. Describe the pathophysiology of Type 1 diabetes. 2. E 1. xplain why urinary tract infections are common in people with diabetes. Explain how acute renal failure could develop. Mr. M. has had the infection for a week and has developed mild ketoacidosis because of the infection. Analysis of arterial blood gases indicates that his serum bicarbonate level is low, and his serum pH is just below normal range. 3. Explain why infection may lead to ketoacidosis. 4. Describe the characteristics of Mr. M's respirations that you would expect to observe while ketoacidosis is present. 5. If Mr. M.'s serum pH continues to decrease below normal, 6. Mr. M. is voiding large volumes of urine (polyuria). Explain 7. Describe three signs of excessive fluid loss. Include the rationale for your answer how would that pH affect cell and organ function? the reason for this. 8. Mr. M.'s vision has deteriorated in the last 3 years because of retinopathy. Explain how retinopathy impairs vision. 9. Describe two problems related to diabetes that Mr. M might encounter because of his reduced vision.Explanation / Answer
1. Diabetes mellitus: ( type 1)
In type 1 diabetes mellitus the main pathology is either quantitative or qualitative deficiency of Insulin. It means that there is either less production(quantitative defect) of insulin from beta cells of the pancreas or the produced insulin is defective(qualitative defect) and can not conduct its activities on glucose metabolism.
2. Reasons are mainly due to high urinary glucose content which favors the bacterial growth. And the second reason is the defective immune response due to high glucose. Hyperglycaemia is a reason for impaired neutrophil function. in hyperglycemia, there is increased intracellular calcium inside neutrophils making the neutrophil impaired. As a result, diapedesis and phagocytosis by neutrophil are impaired. That leads to easy urinary tract infection ( also systemic infection is increased). Other reasons are an antihyperglycaemic drug like SGLT 2 inhibitors..
Most common cause acute renal failure is urinary tract infection and thereby blockage of the urinary tract. In diabetes, there is a urinary tract infection and that can lead to acute renal failure.
3. Uti causes an increase in the production of cortisol and adrenaline. As a result these hormones counteract the effect of insulin and as a result oxidation of fat is further increased and leads to diabetic ketoacidosis.
4. Kussmaul breathing is a deep and labored breathing pattern. In diabetic ketoacidosis which is metabolic acidosis, Kussmaul breathing is seen. As there is acidosis, chemoreceptors in the brain sense the increase H+ in the blood. This is due to increased H+ ion in blood not decreased bicarbonate ions. SO brains drive the respiratory center to exhale out carbon dioxide ( which remains a carbonic acid in the blood circulation), so brain tells the respiratory center to exhale out carbon dioxide to reduce carbonic acid from blood to compensate the metabolic acidosis by reducing carbon dioxide.
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