CASE STUDY 17.6 48-year-old man with diabetes with a history of alco- abuse was

Question

CASE STUDY 17.6 48-year-old man with diabetes with a history of alco- abuse was admitted to the emergency department. He had an elevated heart rate (tachycardia) and was experienc- ing extreme shortness of breath. Blood was drawn for glu- cose and blood gases and urine collected for the assessment of ketones: Glucose Urinary ketones pH pCO po HCO SO. tHb 570 mg/dL Large (reference range, negative) 7.00 48 mm Hg 68 mm Hg 12 mmol/L 81% (calculated) 10 g/dL Question Is the patient's acidemia a result of respiratory or metabolic disturbances or a combination of both 2. If the patient was not having respiratory problems, how would you classify the acid-base disturbance? 3. What is the significance of the urinary ketones that result in terms of identifying the type of diabetes?

Explanation / Answer

The pCO2 in the patient is high. Normal range is 35-45 mm of Hg. The pCO2 of the patient is 48 mm Hg. The SO2 low level, ( normal range 95% - 100 %) and low pO2 ( normal ( 75-100 mm Hg) indicates the condition of hypoxemia. Ph is also lower than the normal. Metabolic acidosis can be caused by hypoxemia whereas, respiratory acidosis occurs when pCO2 is high. Hence, this acidemia is as a result of both metabolic and respiratory acidosis. If the patient would not be having a low pCO2, then the acid base disturbance would be as a result of hypoxemia, low oxygen levels, hence, referred to as being metabolic acidosis. Ketonuria is the condition where, there is presence of high ketone bodies number, present in the urine, that are formed as there would be breaking down of cells. This can be a dangerous condition if the level of ketones would become very high and this needs to be particularly monitored in people having high glucose levels in blood. Ketones in blood are identified to being associated with type 1 diabetes. This is because, ketosis or ketonuria occurs as a result of insulin deficiency and not only hyperglycaemia. This indicates that ketones are present only as a result of very low insulin concentrations so as to control very low concentrations of glucose in blood as well as lypolysis. Hence, it depicts diabetes type 1.

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