Carbohydrate Case Five A 13 year old girl who was a known diabetic, became comat
ID: 124043 • Letter: C
Question
Carbohydrate Case Five
A 13 year old girl who was a known diabetic, became comatose and was rushed to the hospital by her parents. Two days before admission, she went to school feeling ill and vomited that evening. Her vomiting persisted with only a 6-hour pause during sleep. She refused to take her insulin the following morning. The ER physician noted that she was breathing deeply and rapidly and that her breath had a fruity odor. The basic metabolic profile revealed:
Patient
Reference Range
Sodium
129
136-145 mEq/L
Potassium
5.8
3.5-5.1 mEq/L
Chloride
88
98-107 mEq/L
CO2
10
22-28 mEq/L
Glucose
430
74-100 mg/dL
BUN
43
6-20 mg/dL
Creatinine
2.6
0.9-1.3 mg/dL
Calcium
9.2
8.6-10.2 mg/dL
Additional results revealed:
Patient
Reference Range
Cholesterol
525
<200 mg/dL
Triglycerides
3800
<150 mg/dL
Urine tests revealed:
Patient
Reference Range
Glucose
3+
negative
Ketones
3+
negative
Carbohydrate Case Studies
1. Are these results consistent for a known diabetic who did not take the prescribed insulin?
2. What is the significance of a "sweet smelling" breath?
3. What would you expect the patient's blood pH to be?
Patient
Reference Range
Sodium
129
136-145 mEq/L
Potassium
5.8
3.5-5.1 mEq/L
Chloride
88
98-107 mEq/L
CO2
10
22-28 mEq/L
Glucose
430
74-100 mg/dL
BUN
43
6-20 mg/dL
Creatinine
2.6
0.9-1.3 mg/dL
Calcium
9.2
8.6-10.2 mg/dL
Explanation / Answer
1. As you see her report , you come to know that here glucose level is in high concentration and also she refuse to take insulin which is aid in this. Her urine report also say that ketone bodies are present and yes these results are consistent in diabetic patient when they refuse to take insulin.
2. In diabetic body there is large amount of glucose but it is of no used and throw out of body via urine. To generate energy they have to use ketone bodies due to which ketoacidosis occur. Due to this ketoacidosis sweet smell breath come.
3. Here patient is diabetic as well as upper data show she suffered from ketoacidosis means pH is acidic.