Can someone please help me answer questions 1-4. Please do not attempt to answer
ID: 211816 • Letter: C
Question
Can someone please help me answer questions 1-4. Please do not attempt to answer the question unless you can answer all four questions. Thank you
CLINICAL CASE 9 Clinical Case 9/2 ENDOCRINE SYSTEM Diabetes mellitus A 14-year-old male is brought to the ER being found unresponsive. The patient's mother, who had not seen the child for over 24 hours, came home to find her son lying on the sofa unresponsive. Copious quantities of black colored vomit were evident. The child is a diabetic and gives himself his own medication. His mother was unsure when her son last took his medication. Blood pressure: 101/72; heart rate: 123; respirations: 32; oral temperature: 34.8°C,pulse oximetry: 100% on room air General: An approximately 65 Kg, thin male who is, in general, responsive only to very loud or painful stimuli. His oropharynx demonstrates very dry mucous membranes and a moderate amount of dried, black material which is strongly Gastrocult positive. His lungs are clear, but display Kussmaul respiratory pattern. Abdomen exam is negative. There are no other pathological findings. 1. How would you proceed from here? Does this patient need an IV? If so, what types of fluid do you want to initiate and at what rate? 2. What basic lab tests would you order? 3. In addition to saline the patient was given a bolus of 10 units of regular insulin IV while waiting for the lab results, do you find it necessary, too risky? A serum glucose determination (Accucheck) was too high to read. How does this affect your differential diagnosis? What additional care would you now render this patient? The results came back shortly thereafter, and showed an arterial blood gas pH of 6.92, CO2 of 9 and a bicarb of 2. The WBC count was 62.6 thousand (62,600), hemoglobin of 14.4 mg/dL, and hematocrit of 43.5%. His chemistry panel demonstrated a serum sodium of 127, potassium 5.2, chloride of 87, CO2 of less than 4. 5. 5, BUN of 32, creatinine 1.5, and a blood sugar of 1,582. The serum ketones were positive at a dilution of 1:32. What is your interpretation of these results? What additional treatment would you add? a. Blood sugar b. Serum ketones c. Dehydration d. Electrolyte changes; What type of acidosis is this? e. BUN and creatinine f. WBC 6. What might trigger a DKA? 7. Would you administer antibiotics?Explanation / Answer
Both the case studies, symptoms discusses about the Diabetic ketoacidosis disease.Diabetic ketoacidosis is a potentially fatal complication of diabetes that occurs when we have less insulin than our body needs it causes the blood to become acidic and the body gets severerly dehydrated.
If we don’t get enough insulin in our blood, our liver is programmed to manufacture emergency fuels. These fuels, made from fat, which are called ketones (or keto acids). However, if our body stays dependent on ketones for energy for too long, we soon will become ill. In diabetic ketoacidosis, ketones build up in the blood, alters the normal chemistry of the blood and interfering with the function of multiple organs. They make the blood acidic, which causes vomiting and abdominal pain.
Ketoacidosis is always accompanied by dehydration, which is caused by high levels of glucose in the blood. Ketoacidosis, is common for blood sugar to rise to a level over 400 milligrams per deciliter. When blood sugar levels are so high, some sugar "overflows" into the urine. As sugar is carried away in the urine, water, salt and potassium are drawn into the urine with each sugar molecule, and our body loses large quantities of your fluid and electrolytes, which are minerals that play a crucial role in cell function People with type 1 diabetes are at risk of diabetic ketoacidosis.
Symptoms of diabetic ketoacidosis include:
As blood ketone levels increase, the person's breathing pattern become slow and deep, and his or her breath can have a fruity odor. A person with ketoacidosis may seem to be tired or confused or may have trouble paying attention. Without prompt treatment in the first day of symptoms, the illness may cause low blood pressure, a loss of consciousness, coma or death.
People with diabetic ketoacidosis are always treated in a hospital. Doctor will test blood for levels of glucose, ketones, and electrolytes such as sodium and potassium. If been taking your insulin without missed doses, your doctor will want to determine if you have an infection.Symptoms of diabetic ketoacidosis can develop over a period of a few hours, and treatment results in rapid recovery. Commonly, people who develop ketoacidosis
Ans.1 :
Diabetic ketoacidosis requires treatment in a hospital, often in the intensive care unit. Patient receives a large volume of fluids intravenously (through a vein) and insulin to lower blood sugar and to correct the acidosis. Blood sugar and acid levels has to be monitored frequently, and should be given potassium supplements to restore your body's supply of this essential mineral. Until, blood chemistry returns to normal, vital signs (temperature, pulse, respirations, blood pressure) and urine output should be monitored closely. If an infection has triggered episode of ketoacidosis, antibiotics or other medications will be used to treat the infection.
Ans. 2 : Tests recommended in the diagnosis of diabetic ketoacidosis:
Ans. 3:
In addition to saline the patients was given a bolus of 10 units of regular insulin IV, before the lab report seen.
According to practitioner,Insulin should be started about an hour after IV fluid replacement is started to allow for checking potassium levels and because insulin may be more dangerous and less effective before some fluid replacement has been obtained.
Although the incidence of life-threatening hypokalemia due to aggressive insulin administration is very low, there is little to no advantage in starting insulin prior to rehydration and evaluation of serum potassium levels. Initial bolus of insulin does not change overall management of DKA.
Ans. 4:
High levels of ( serume glucose determinations) ketones in the blood can indicate:
Depending on the severity, insulin may be given intravenously or by injection under the skin. Usually potassium is given to prevent the development of low blood potassium. Throughout treatment blood sugar and potassium levels should be regularly checked. Antibiotics may be required in those with an underlying infection. In those with severely low blood pH, sodium bicarbonate may be given.
Instructions include advice on how much extra insulin to take when sugar levels appear uncontrolled, an easily digestible diet rich in salt and carbohydrates, means to suppress fever and treat infection, and recommendations when to call for medical help.