Chief Complaint:8-year-old girl with excessive thirst, frequent urination, and w

Question

Chief Complaint:8-year-old girl with excessive thirst, frequent urination, and weight loss. History: Cindy Mallon, an 8-year-old girl in previously good health, has noticed that, in the past month, she is increasingly thirsty. She gets up several times a night to urinate, and finds herself gulping down glassfulls of water. At the dinner table, she seems to be eating twice as much as she used to, yet she has lost 5 pounds in the past month. Irn the past three days, she has become nauseated, vomiting on three occasions, prompting a visit to her pediatrician. Questions: 1. At the doctor's office, blood and urine samples are taken. The following lab results are noted: blood glucose level 545 mg/dl (normal 50 170 mg/dl) blood pH level 7.23 urine tested positive for glucose and for acetone / acetoacetate (i.e. ketone bodies) (normally urine is free of glucose and ketone bodies) (normal 7.35-7.45) Questions 1. Why is her blood-glucose level elevated? 2. Why is her blood pH level decreased? At the office, Cindy is breathing rapidly and taking deep breaths. What physiological purpose does this serve? 3. your ansuuer on n

Explanation / Answer

1.diabetes mellitus is one of several persistent conditions causing high blood sugar levels. For someone with diabetes, hyperglycemia has many possible causes:

2. Briefly and simply, insulin governs the entry of glucose into the cell, and glucose is the principal fuel for the body as a whole. When there an insufficient supply of insulin as the body breaks down fat as an alternative source of energy. This breakdown is incomplete though because ultimately it depends on normal glucose metabolism. As a result, there is an accumulation of 'ketoacids' such as acetoacetic acid. These acids in turn build up, as any acid will, and there is accumulation of hydrogen ions. Since pH is an expression of the reciprocal of the logarithm of the concentration of hydrions, there may be a fall in pH (In this case, from the normal level of 7.40 in the blood to 7.23, a significant change).

3.Rapid or laboured breathing, known as Kussmaul breathing, can be a symptom of diabetic ketoacidosis (DKA). Ketoacidosis is a short term complication of diabetes caused by very high blood glucose levels accompanied by a high level of ketones in the blood. Ketoacidosis will only usually affect people with diabetes if they haven't taken sufficient insulin.

4.When diabetes is not managed well, the body does not make enough insulin to break down glucose in the blood. This means that the body's cells do not receive enough glucose to use as energy.When the body cannot get its energy from sugar, it switches to burning fat for fuel instead. The process of breaking down fat to use as energy releases by-products called ketones.Ketone bodies include acetone. Acetone is the same substance that is used in nail varnish remover and is distinguished by its fruity smell.When a person with diabetes has breath that smells of acetone, it is because there are high levels of ketones in their blood.

5.The effects of glucagon are the opposite of the effects induced by insulin. The two hormones need to work in partnership with each other to keep blood glucose levels balanced.Glucagon is a hormone that is produced by alpha cells in a part of the pancreas known as the islets of Langerhans.

The role of glucagon in the body : Glucagon plays an active role in allowing the body to regulate the utilisation of glucose and fats.Glucagon is released in response to low blood glucose levels and to events whereby the body needs additional glucose, such as in response to vigorous exercise.

When glucagon is released it can perform the following tasks:

Glucagon and blood glucose levels :Glucagon serves to keep blood glucose levels high enough for the body to function well.When blood glucose levels are low, glucagon is released and signals the liver to release glucose into the blood.

Glucagon secretion in response to meals varies depending on what we eat:

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