Tonya, a 20 yr old woman, brought to the hospital ER in comatose state. Her room
ID: 83463 • Letter: T
Question
Tonya, a 20 yr old woman, brought to the hospital ER in comatose state. Her roommate states she had been nauseated earlier in the day. Upon examination, it was noted that patient was breathing deeply and rapidly. Her breath had a fruity odor and mucous membranes were dry. Family members contacted stated the woman’s older brother had Type I diabetes.
Laboratory results;
Na+ 128 mmol/L
K+ 5.7 mmol/L
Cl- 88 mmol/L
HCO3 9 mmol/L
BUN 50 mg/dL
Serum Osmolality 310 mOsm/kg
pH 7.12 pCO2 28 mm Hg
Serum glucose 780 mg/dL
Urine glucose 4+
Serum acetone 3+ Hgb 17.6 g/dL
HCT 53 %
WBC 12,000
RBC 6.0 million
Differential normal
Questions:
a.. Identify abnormal lab values (15)
b. On basis of patient’s history and laboratory results, what would likely be Tonya’s problem?
c. Which of the lab findings is most valuable in establishing the fact she could have diabetic ketoacidosis?
d. What are the three major ketone bodies?
e. The nitroprusside chemical reaction may be used to indicate a positive serum acetone reacts with which chemical compound?
f. Would insulin levels be increased, decreased or normal in this patient? Why?
g. Why does the patient exhibit glycosuria?
h. After discharge with an insulin regimen, what laboratory procedure would be of most value in determining the glucose control over a period of time?
Explanation / Answer
Ans-a Serum osmolarity, hco3 value and RBC are present also potassium level are abnormal.
Ans-b Tonya may be suffered from diabetes and diabetes ketoacidosis
Ans-c hco3 level and serum osmolarity are the factors which tells about ketoacidosis
Ans-d acetone, acetoacetate and beta hydroxybutyrate.
Ans-e amonium hydroxide is used with sodium nitropruside to detect cystine.
Ans-f the insulin level will be decreased
Ans-g because itvsufferrd from diabetes so it have exhibit glycosurea.
Ans-h oral glucose tolerance test and HbA1c test