Ldrennanblog – medical students



CASE STUDYChief 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 glassfuls 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 of FormQuestions:1. At the doctor's office, blood and urine samples are taken. The following lab results are noted: blood glucose level = 545 mg/dlblood pH level = 7.23 (normal = 50 - 170 mg/dl)(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) Why is her blood-glucose level elevated?________________________________________________________________________________________________________________________________________________________________________________________________Why is her blood pH level decreased? (acidotic)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________At the office, Cindy is breathing rapidly and taking deep breaths. What physiological purpose does this serve?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________D. Cindy has a fruity odor to her breath. Do you know why?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________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.________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________2. Following her visit to the pediatrician, Cindy undergoes a diabetic care training program, learning how to self-inject insulin subcutaneously and check her blood-glucose level at home with chemstrips. In addition, she learns the importance of carrying candy and glucose tablets with her at all times, as well as eating the right amounts of food at the right times each day.A. What dangers confront Cindy as she gives herself insulin artificially on a daily basis? Why must she carry candy and glucose tablets with her at all times?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________3. Cindy returns to her pediatrician three months later for a re-check, and is found to have a glycosylated hemoglobin level (Hb A1C) of 9.5%. A. What is glycolsylated hemoglobin? What is the normal range for glycosylated hemoglobin?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________B. What does Cindy's Hb A1C level indicate that a one-time direct measurement of blood glucose doesn't indicate?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________4. The years progress, and Cindy has considerable difficulty controlling her diabetes. She has been told that she has "brittle" diabetes, a form of the disease marked by wide swings in blood-glucose levels despite the best efforts at control. Cindy is advised by her physician that she is at risk for developing certain complications of diabetes.A. What are the possible long-term complications of her disease?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________B. Cindy is advised that she must take very good care of her feet, never walking barefoot. Why is this important?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________5. In her mid-forties, Cindy began to show early signs of diabetic nephropathy (kidney disease), consisting of persistent proteinuria, hypertension, and gradually decreasing renal function as measured by chemical tests. She nonetheless felt fairly healthy over the next 10 years. At age 55, however, she has noticed becoming increasingly fatigued upon mild physical exertion and requiring more sleep than previously. In addition, she has generally felt nauseated most of the time, and in the past two weeks, has vomited on several occasions. She has increased swelling in her ankles, and is short of breath. She has also become less responsive over the past day or so. Laboratory tests reveal that her kidney disease is now progressing at a much faster rate: BUN (blood urea nitrogen) = 56 mg / dl (normal = 10 - 20 mg / dl) Urinary output = 25 cc / hour (normal = 50-60 cc / hour) Cindy is advised by her physician that her kidneys are failing. She is informed about treatment options: hemodialysis vs. continuous ambulatory peritoneal dialysis (CAPD) vs. kidney transplant. In consultation with her physician, Cindy chooses to undergo hemodialysis. Explain the difference in hemodialysis and peritoneal dialysis__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Bottom of Form ................
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