Question

Max is a 18 year old college student with insulin-dependent diabetes mellitus (Type 1). Recently, Max has been staying up late to study for final exams. Last night while studying, he shared a full box of cupcakes with his friend. Overnight Max woke up feeling thirsty and in need of urinating. Upon awakening to get ready to take his exam, he tells his friend that he is feeling light headed and his heart is racing. While brushing his hair, he realizes his legs are wobbly; and he panics realizing he forgot to take his insulin yesterday. He calls out to his friend, who finds him in the bathroom unconscious. He is transported by ambulance to the nearby emergency department. Below are the result of his physical and laboratory tests. Physical Exam and Laboratory Values Heart Rate 135 bpm Respirations 32/minute; slow and deep Blood Pressure 90/40 Plasma Levels Glucose 540 mg/dl Na+ 134 mEq/L (normal = 140 mEq/L) K+ 5.8 mEq/L (normal = 4.5 mEq/L) Cl- 96 mEq/L (normal = 105 mEq/L) HCO3- 8 mEq/L (normal = 24 mEq/L) Ketones ++ (elevated) Urine Glucose 4+ (normal = none) Arterial Blood Arterial Blood - PO2 110 Hg (normal = 100 mm Hg) Arterial Blood - PCO2 20 mm Hg (normal = 40 mm Hg) Arterial Blood - pH 7.22 (normal = 7.4)

1. What acid-base disorder does Max have and explain your reasoning? Is it a simple or mixed acid-base disorder? In your answer, discuss the etiology of Max's acid-base disorder.

Answer 1

1.max has DIABETIC KETOACIDOSIS

Diabetic ketoacidosis is diagnosed by his high blood sugar levels of 540mg/dl (indicates lack of absorption of glucose by body )associated with decreased blood pH-7.22 and elevated ketone bodies.

It is associated with METABOLIC ACIDOSIS which is indicated by very low plasma HCO3 and increased heart rate and breath rate.

2.It is a MIXED acid base disorder .

3. Etiology-

Max has type 1 diabetes mellitus. He was supposed to take his insulin but forgets and skips it and as a result the following changes occurs-

Due to lack of insulin there is no absorption of glucose by his cells for it's metabolic activities.

As a result his body chooses alternative pathway and switches to breakdown of fats as a compensatory mechanism.

Breakdown of fats results in buildup of acids in bloodstream called ketone bodies thus pH is lowered.

As bicarbonate acts a buffer it binds to the acid produced. As a result there is decreased bicarbonate levels in the body.

Metabolic acidosis decreases the pH of arterial blood and stimulates the chemoreceptors

As a result there is increase in ventilation.this increased ventilatory drive is responsible for decreased PaCO2

Treatment for diabetic ketoacidosis is

ADMINISTRATION OF INSULIN and REPLACEMENT OF ELECTROLYTES AND FLUIDS.

And for metabolic acidosis

INTRAVENOUS INFUSION OF BICARBONATES.