I need 3 possible diagnoses thats can be causing this symptoms. Please take note

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I need 3 possible diagnoses thats can be causing this symptoms. Please take note of the family history and past illness when diagnosing. please detail why you chose those 3 diagnoses, and how they can be tested for

53% OOOOO AT&T; 3:55 PM bbhosted cuny edu Bio240 Individ Student's name: Project 1 Jim, a 13ryear old boy, has been diagnosed with diabetes type 1 for 3 years, was brought to the by his parents. He com ns of abdominal pain and constant feeling nauseated and emergency room vomiting since this afternoon. He has been coughing and sneezing for the past 4 days with mild fever hat has been treated with Tylenol and his mother's delicious chicken soups. Jim has diabetic insulin shots that were prescribed by his pediatrician and Jim is able to do it on own 2 times a day, and he has been comply with this regiment. The last shot he did was about 3hours before he was brought to he emergency room. Physical examination Pulse: 110x/minute (normal 601000 Respiration rate: 30 x/minute (normal: 15-20) Temperature: 40 Celsius normal: 36.1°-37.2°) On sniffing his breath, it smells "fruity" His lungs: are clear on auscultation, rapid brea His heart: heart sounds normal l, no enlargeme Abdomen: no pain on palpation, complaint of dull pain all over the abdomen All other physical exam normal for patient's age Chief complaint (fill this in based on the short history above): abdominal pain, nausea and vomiting History of present illness: Gill this based on the story above, making summary of his current illness): (how long does he has cough, fever, sneezing He has cough, fever, and sneezing for 4 days (how long does he has abdominal pain, nausea and vomiting) He complaints of abdominal pain, nausea and vomiting since this afternoon (what treatment he has taken for the current illness) He has taken Tylenol History of past illness Cfill this based on the story above, making summary of his past/chronic illness) Jim has been diagnosed with diabetes type 1 for 3 years and he has taken insulin shots that he manages it himself twice a day. The last time he did was 3hours before admission tothe ER. (til this based on the story above, making any relevontfamily historyifany Possible diagnoses Differential diagnoses): (write the order from the most likely to the least like diagnoses) 1. Diabetic ketoacidosis (DKA Hyperglyce Hypoglycemia Explanation of pathophysiology of each of the differential diagnoses: (explain the pathophysiology of the differential diagnoses you choose above in 35 paragraphs each, along with the reason you think this patient fit your diagnoses) 1. Diabetic ketoacidosis (DKA) pathophysiology: 3-5 paragraphs. In this case, Jim's DKA is probably exacerbated by a common cold or other upper respiratory tract infection. Student's name Bio240 Individual Project 1 2. Hyperglycemia in diabetes mellitus type 1, pathophysiology: 3-5 paragraphs. In this case, probably Jim has not comply with his insulin shot, but he has not develop ketosis as yet. Hypoglycemia pathophysiology: 3-5 paragraphs. In this case, probably Jim has been taking his insulin shots but he doesn't have enough food intake due to his nausea and vomiting. It makes his blood sugar lower than normal, and insulin shots make it even lower. Hence hypoglycemia Suggestion of what extra work laborato dia nformation needed to come to a more definite diagnosis for this patient (give so s suggestionis) you can your differential diagnoses t a for this patient). In this case: to make DKA diagnoses, look at page 180 of your text. You more accurate can refer to your textbook or other sources (medline, mayo clinic or Medscape) 1. Blood glucose level: to determine if it is hyperglycemia or hypoglycemia 2. Urine glucose level: to determine glucosuria 3. Blood potassium level: to determine hyperkalemia, help diagnosing low insulin level 4. Ketone bodies in blood and urine: to determine the presence of ketone bodies in the blood

Explanation / Answer

Laboratory tests, including blood and urine tests, are used to confirm a diagnosis of diabetic ketoacidosis. Arterial blood gas measurement is usually performed to demonstrate the acidosis; this requires taking a blood sample from an artery. Subsequent measurements (to ensure treatment is effective). At very high levels, capillary blood ketone measurement becomes imprecise. In addition to the above, blood samples are usually taken to measure urea and creatinine (measures of kidney function, which may be impaired in DKA as a result of dehydration) and electrolytes. Furthermore, markers of infection (complete blood count, C-reactive protein) and acute pancreatitis (amylase and lipase) can also be measured. Given the need to exclude infection, chest radiography and urinalysis are usually performed. If cerebral edema is suspected because of confusion, recurrent vomiting or other symptoms, computed tomography may be performed to assess its severity and to exclude other causes such as stroke.

HLA-associated high-risk genotypes are associated with a high chance of presenting DKA at diabetes onset. However, having at least one FDR with T1D reduced the risk of DKA regardless of HLA genotype. thus family historyplay a role for the cause of diabetic ketoacidosis.

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