T.J., a 6-year-old boy, was rushed to the emergency room in a state of disorient
ID: 127300 • Letter: T
Question
T.J., a 6-year-old boy, was rushed to the emergency room in a state of disorientation. His parents report that he has been really thirsty over the past few weeks; he has been waking up two to three times per night asking for water. He has also started wetting the bed again, something he hasn’t done for about 6 months. He has also been really tired despite eating a lot more than his friends and his pants are becoming loose. His blood glucose is measured at 413 mg/dL. His urine is positive for ketones. He is diagnosed with diabetes.
1. What type of diabetes does T.J. most likely have given his presentation?
2. What is the cause of his diabetes?
3. Describe the pathophysiologic changes that have occurred over the past weeks/months/years.
4. What is the significance of ketones in his urine?
5. What is the significance of hyperglycemia?
6. How do the presenting clinical manifestations relate to beta cell destruction?
7. What key elements would you anticipate to be a part of his treatment plan?
8. What would be the goal of his treatment and how would you know he is meeting this goal?
Please answer all questions.
Explanation / Answer
The type of diabetes does T.J. most likely have given his presentation is Diabetes type 1. Most probably the genetic predisposition is the cause of his diabetes. The pathophysiologic changes that have occurred over the past weeks are uncontrolled blood sugar levels leading to; ketones in urine. Ketonuria is the presence of ketone bodies in the urine a condition seen in seen when the body produces excess ketones as an indication that it is using an alternative source of energy. Seen more commonly in type I diabetes mellitus. The significance of hyperglycemia is the confirmation of Diabetes type 1 in this case to the premature onset. The key elements that I would anticipate to be a part of his treatment plan are; low carbohydrate diet, exercise, and insulin therapy. The goal of his treatment would be to restore the normal sugar level. I would ensure that he is meeting this goal by keeping a record of his sugar levels by monitoring it regularly and given insulin shorts.
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