David Falcon is a 10-year-old boy who has been admitted to the hospital with typ

Question

David Falcon is a 10-year-old boy who has been admitted to the hospital with type 1 diabetes mellitus. He recently experienced weight loss of 20%, constant hunger, and increased urination. He has felt in creasingly sick and began vomiting this morning. On admission he became less responsive, confused, and nearly unconscious with rapid deep respirations. Physical examination reveals dry skin and dry mucous membranes. His breath has a fruity odor. His initial lab results reveal a blood glucose of 450 mg/dl, positive urine and blood ketones, arterial blood pH of 7.25, Pco_z of 40 nun Hg, and HCO_3^- of 16 mEq/L. Treatment of intravenous fluids with electrolytes and insulin was started and resulted in improvement in David's symptoms. Which of the following responses best explains David's symptoms of increased thirst and increased urination? A. Breakdown of fatty acids in the liver B. Hyperosmolar body fluids C. Loss of potassium in the urine D. Gluconcogenesis in the liver David's initial arterial blood gas values represent which of the following conditions? A. Compensated metabolic alkalosis B. Uncompensated metabolic alltalosis C. Uncompensated metabolic acidosis D. Compensated metabolic acidosis The body has many ways of responding to alteration in blood pH. David's respiratory pattern is one of these. What is the effect of his rapid deep respirations on blood acid-base balance. A. Increases blood pH B. Decreases blood pH C. Increases blood CO_2 D. Decreases blood NaHCO_ 3 David's vomiting is a symptom of ketone production, and he has ketones in both his blood and urine. Which of the following physiological mechanisms is most likely responsible for his ketosis? A. The rate of carbohydrate metabolism has increased. B. The rate of protein catabolism has decreased. C. The rate of fat catabolism has increased. D. The rate of fat catabolism has decreased.

Explanation / Answer

The second option is correct. The excessive urination, excessive thirstiness, and unconsciousness reveal that the body fluids get hyperosmolarity. The hyperosmolarity cause increased thirstiness and body increased urine excretion to expel out increased sugar. The PCO2 level is alright but HCO3 level is low and hence it is the symptom of compensated acidosis. The option D is correct. Rapid and fast breathing causes depletion in blood Carbon dioxide level, which increases blood pH. The option A is correct. It is the case of Ketoneuria where body depletes of energy sources and use ketone bodies. This is common in type 1 diabetes patient where body converts fats into ketones because these produce by fat catabolism. Therefore, the option C is correct.

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