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) D. Cindy has a fruity odor to her breath. Why? Explain why this is occurring. E. Explain why Cindy is urinating so frequently. 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

D When there is non availability of glucose to body in form of glycogen our body shifts to use ketones as sources of energy and high level of ketones metabolism in body can cause breath to smell as of fruit or smell like nail polish. YThhe rise of ketones levels in body is not safe and may lead to condition called diabetic ketoacidosis (DKA) which includes a sweet and fruity odor on your breath as symptoms.

E  In the case Diabetes ketoacidosis as there is increased levels of glucose in blood, generally filtration of glucose and reabsorption of glucose is done in tubules of kidneys in case of normal person but in case of affected person by DKA increased levels of glucose causes increased amount of glucose in tubule which caused more input of water from kidneys into tubules and nephrons by osmosis and causes frequent urination.

F In the case of starvation the levels of glucose in blood drops and body makes energy source from reserved food material like glucagon, there is an up-regulation of glycogenolysis, gluconeogenesis, lipolysis, and ketogenesis. The body’s glycogen stores are consumed in about 24 hours ketone bodies through ketogenesis. Acetoacetate breaks down spontaneously into acetone, and the acetone is released through the urine and lungs to produce the “acetone breath” that accompanies prolonged fasting.

G In patients with diabetic ketoacidosis, is that children are closely monitored and a changing status is promptly addressed. Give oxygen, although this has no effect on the respiratory drive of acidosis. Diagnose by clinical history, physical signs, and elevated blood glucose.Fluid, insulin, and electrolyte replacement is essential in the treatment of diabetic ketoacidosis.Early in the treatment of diabetic ketoacidosis, when blood glucose levels are very elevated, the child can continue to experience massive fluid losses and deteriorate. Strict measurement of fluid balance is essential for optimal treatment. Organize outpatient care through the pediatric diabetes care team.

Consult a neurosurgeon if cerebral edema is suspected. Once the child has recovered, he or she can resume a normal diet. Proper counseling and behavioral care should be taken parents should be educated about the situation and should be instructed and proper and timely medication. A stress free and normal environment should be maintained at all times. Treatment can be riskful if the child faces stressful condition.

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