Question

Dom, age 9, made the Alliance travel soccer team and was excited to be able to play right wing. At 5’3” (160 cm) and 105 lbs. (48 kg), he was taller and thinner than most of his teammates. Practices began August 15, and his first away game was against Midwest United in Grand Rapids. Dom had lost weight in the past month, and he always seemed to be hungry and thirsty. He had an appointment with the eye doctor in the next week because he told his mother that sometimes the blackboard in the classroom was blurry. Last week, he had a cold, followed by a “stomach bug.” He seemed to be better, and then now he said he just had “butterflies.” These must just be “nerves for his big game”, thought his mother. She was worried about him getting dehydrated in the late summer heat and developing muscle cramps, so she had him eat a banana and packed extra coconut water for him. “This is new, Dom”, she said. “It tastes great, and it has potassium, which is really good for you”.

Dom played well during the first quarter, defending five shots on goal and getting a goal himself. He was hot, and sweaty, so he drank a bottle of the coconut water and went out for the second quarter. He began to feel tired and a little queasy, and his stomach began to hurt. Then he began to cough and started to stagger. His coach noticed something was wrong, so he brough him to the bench. Dom’s teammate, Cameron mentioned that Dom’s breath smelled a little fruity. “Have some more water, Dom” the coach said. After slowly sipping a second bottle of coconut water, Dom stood up, clutched his stomach and then passed out. “He’s breathing funny!” shouted the coach. He called 911. Dom’s pulse was hard to feel, so the coach put his head on Dom’s chest and then could tell that it was beating very fast. The paramedics arrive in a few minutes and began to work on Dom. They checked his vital signs and used a glucometer to check his blood glucose level. It was 361 mg/dL. They immediately gave him 10 units of IV insulin bolus and transported him to the emergency department.

Questions

1. What disease did Dominick likely develop? What leads you to this conclusion?
2. Describe the pathophysiology of Dom’s disease, and explain how it differs from other forms of the disease.
3. What are the early symptoms of this disease in children?
4. What is the epidemiology of this disease in children? Discuss genetic and environmental factors that play a role in the development of the disease.
5. What complications of this disease does Dom now have? What is the pathophysiology of this complication and possible consequences (sequelae)?
6. What are four goals in treating Dom for this complication? How will Dom be treated? Explain how his treatment will affect the pathophysiology of his disease.
7. What is the composition of coconut water? What electrolyte imbalance could Dom have experienced because he consumed significant amounts for rehydration?
8. When Dom arrived at the emergency department, he was assessed for cerebral edema. What is cerebral edema, and why was he at risk for it? How would he be treated to reduce this risk?
9. Make a concept map of the triggers, symptoms and the pathophysiology of Dom’s problem.

Answer 1

#Dominick has likely developed Diabetes .It can be categorized into type 1 diabetes

#The following signs and symptoms has to this conclusion

• Elevated blood glucose levels (361mg/dL)
• Fruity breath odour
• Weight loss
• Blurry vision
• Hungry
• Thirsty

#The pathophysiology of the disease condition is as following

When there is an alteration in the endocrine system of pancreas,various causes and risk factors . The insulin secretions or productions are altered or reduced or even completely stopped. Normally when food is consumed it is broken down into glucose and reaches the blood stream. Insulin is needed to push this glucose into the cells to produce energy. But lack of insulin leads to retention of glucose in the blood and resulting in hyperglycemia .As the cells as not received energy ,the Hunger center is stimulated making the patient to eat more or hungry. Simultaneously the acid base imbalance occurs resulting in ketoacidosis. In this condition the patient may experience stomach bugs, altered thirst. The respiratory system is affected in gaseous exchange making the breath odour to be fruity because of acid base imbalance .If the patient is not correctly diagnosed and treated can land up in unconsciousness and further consequences .

#The early symptoms of this disease in children are

• The children will be very hungry
• The children will have increased thirst
• Changes in vision level like blurry vision
• Weight loss
• Stomach bugs
• Fruity breath odour in severe cases.