Question

Endocrine pathophysiology

Diabetes case study

A 21-year old female (A.M) presents to the urgent care clinic with symptoms of nausea, vomiting, diarrhea, and a fever for 3 days. She states that she has Type I diabetes and has not been managing her blood sugars since she’s been ill and unable to keep any food down. She’s only tolerated sips of water and juices. Since she’s also been unable to eat, she hasn’t taken any insulin as directed. While helping A.M. from the lobby to the examining room you note that she’s unsteady, note that her skin in warm and flushed and that she’s drowsy. You also note that she’s breathing rapidly and smell a slight sweet/fruity odor. A.M. has a challenge answering questions but keeps asking for water to drink.

You get more information from A.M. and learn

• She had some readings on her glucometer which were reading ‘high’
• She vomits almost every time she takes in fluid
• She hasn’t voided for a day but voided a great deal the day before
• She’s been sleeping long hours and finally woke up this morning and decided to seek care

Current labs and vital signs:

1. What is the pathophysiology for the condition you believe A.M. has?
2. Relate the etiology and clinical manifestations for the condition you identified for A.M.

Answer 1

#. Diagnosis is Diabetic ketoacidosis

#. Etiology for A.M :-

Infection (40%); insulin is needed with an infection and the lack of insulin is what can cause DKA (missed insulin also a cause)

Other causes are :-

Trauma

Pregnancy

Newly diagnosed or previously unknown diabetes

#. Pathophysiology :-

lack of insulin causes serum glucose levels to rise

fatty acid levels are increased

beta-oxidation of free fatty acids leads to ketosis

ketonuria develops and if excretion of these products is inhibited (due to dehydration), then plasma H+ concentration increases

Pathophysiology :-

ketogenesis due to insulin deficiency leads to increased serum levels of ketones anad ketonuria

acetoacetate, beta-hydroxybutyrate; ketone bodies produced by the liver, organic acids that cause metabolic acidosis

respiration partially compensates; reduces pCO2, when pH < 7.2, deep rapid respirations (Kussmaul breathing)

acetone; minor product of ketogenesis, can smell fruity on breath of ketoacidosis patients

#. Clinical presentation relating to A.M :-

fruity or acetone breath, nausea/vomiting, dehydration, polydipsia, polyuria, deep, rapid breathing (Kussmaul)

Other signs and symptoms :-

lethargy, weakness, headache