Carbohydrate Case One A 42 year old man presented to his physician\'s office com
ID: 124044 • Letter: C
Question
Carbohydrate Case One
A 42 year old man presented to his physician's office complaining of fatigue, fever, dizziness, malaise, and a rash in his groin area that had not responded to antibiotic cream. He further complained of increased urination and constant thirst. Physical checkup revealed the patient to be overweight. Vital signs on presentation were BP 130/80, heart rate 90, respiratory rate 25 breaths/minute. His father had been diagnosed with DM II at age 46 and the patient's older sister also was diagnosed with DM II. A CMP and Lipid profile was ordered to be drawn the following day as a fasting sample.
The CMP results were as follows:
Patient
Reference Range
Sodium
143
136-145 mEq/L
Potassium
3.4
3.5-5.1 mEq/L
Chloride
104
98-107 mEq/L
CO2
28
22-28 mEq/L
Glucose
135
74-100 mg/dL
BUN
10
6-20 mg/dL
Creatinine
1.1
0.9-1.3 mg/dL
Calcium
9.2
8.6-10.2 mg/dL
Total Protein
6.9
6.4-8.3 g/dL
Albumin
4.2
3.5-5.2 g/dL
Total bilirubin
0.5
0-2.0 mg/dL
ALP
56
53-128 U/L
AST
36
<35 U/L
ALT
18
<45 U/L
Lipid Profile results:
Patient
Reference Range
Cholesterol
136
<200 mg/dL
HDL Cholesterol
66
>40 mg/dL
LDL Cholesterol
61
<100 mg/dL
VLDL Cholesterol
9
<30 mg/dL
Triglycerides
45
<150 mg/dL
Carbohydrate Case Studies
1. Which laboratory results are of concern?
2. What would be the next course of action?
3. A fasting blood glucose was drawn a week later. The result was 130 mg/dL. What is the significance of this result?
Patient
Reference Range
Sodium
143
136-145 mEq/L
Potassium
3.4
3.5-5.1 mEq/L
Chloride
104
98-107 mEq/L
CO2
28
22-28 mEq/L
Glucose
135
74-100 mg/dL
BUN
10
6-20 mg/dL
Creatinine
1.1
0.9-1.3 mg/dL
Calcium
9.2
8.6-10.2 mg/dL
Total Protein
6.9
6.4-8.3 g/dL
Albumin
4.2
3.5-5.2 g/dL
Total bilirubin
0.5
0-2.0 mg/dL
ALP
56
53-128 U/L
AST
36
<35 U/L
ALT
18
<45 U/L
Explanation / Answer
Sodium, potassium and glucose levels are of special concern. Decreasing level of potassium, increased level of sodium and high level of glucose are of concern and are indicator of diabetes disorder. The next course of action should be change in lifestyle, weight control by physical exercise, controlled diet and proper medication to control the glucose level and electrolyte balance. The result indicates that there is improvement in the condition, and glucose level is decreasing but the rate of decrease is less. Proper medication and lifestyle changes needs to be followed to control glucose levels within short duration of time as the patient has family history of DM II and the condition can get worsen if not controlled.