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

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. In the past three days, she has become nauseated, vomiting on three occasions, prompting a visit to her pediatrician. Results: 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 (normal = 7.35-7.45) urine = tested positive for glucose and for acetone/acetoacetate (i.e. ketone bodies) (normally urine is free of glucose and ketone bodies) F. How is Cindy's condition like that of starvation? Address the role of glucagon in your answer. G. How do you think the pediatrician is going to treat Cindy's condition? Are there any risks or potential complications to her treatment?

Explanation / Answer

Answer:

F. Glucagon is higher than insulin in both starvation and diabetes. This prevents the cells in getting the nutrients that they require. During starvation, no food is being taken in for the cells to gain nutrients and energy. In diabetes, there is no insulin to catabolize the nutrients and provide nutrition to the cells.

G. The pediatrician is expected to treat Cindy with doses of insulin. He should also suggest her to undergo the diabetic care training program such that she can self inject appropriate doses of insulin and monitor her blood glucose level with diabetic test strips.

There are potential risks of self injecting with insulin as the doses injected by her may not be appropriate, which might result in abrupt increase or decrease in blood glucose levels. So, she should be advised to keep candies and glucagon with her. The candies would help her if her blood glucose level gets too low (hyperglycemia and insulin shock). Glucagon would help her prevent diabetic ketoacidosis if the blood glucose level rises.

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