Endocrine Clinical Scenario Patient information: 12 year old female with excessi
ID: 3513170 • Letter: E
Question
Endocrine Clinical Scenario Patient information: 12 year old female with excessive thirst, frequent urination, and weight loss Background: Veronica Donny, a 12-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 Segment1 Questions 1. At the doctor's office, blood and urine samples are taken. The following lab results are noted blood glucose level 545 mg/d (nrmal 50- 170 mg/dI) blood pH level7.23 urine tested positive for glucose and for acetone acetoacetate (i.e ketone bodies) (normally urine is free of glucose and ketone bodies) (normal 7.35-7.45) A. Why is her blood-glucose level elevated? B. Why is her blood pH level decreased? C. 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? 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 answerExplanation / Answer
This is typical case of Type I Diabetes with Ketoacidosis
A). She has hyperglycemia because of Insulin deficiency. Action of Insulin is to decrease blood glucose by promoting it uptake by muscle, liver and its metabolism.
B). Blood pH is low because of accumulation of keto acids (like acetoacitic acid) in her blood. In insulin deficiency the body in unable to utilize glucose for metabolism thus body use fatty acid oxidation pathway for energy and byproduct of this pathway is keto acid which accumulate to cause Ketoacidosis.
C). This is due to Compensate metabolic acidosis (which happens due to accumulation of keto acid). Body tries to increase pH by bicarbonate and CO2 accumulate in lung as a result of this. Thus there is hyperventilation to remove excessive CO2.
D). Acetoacitic acid (product of fatty acid oxidation) is spontaneously converted to Acetone which has fruty odour this imparts urine fruty odour.
E) Glucose is osmotic substance. When there is hyperglycemia then it is excreted from kidney and water follows it therefore it causes execess urination (osmotic diuresis).
F). In starvation there is deficiency of glucose so body utilize fats for metabolism (by fatty acid oxidation). Byproduct of this pathway is ketone thus it alsomay cause Ketoacidosis. GlucaGon is antagonist hormone that acts to increase blood glucose (thus preventing hypoglycemia) as tjere is hyperglycemia so glucagon secretion is low.
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