Question

an 18-year-old male high school student who had a 4-year history of diabetes mellitus was brought ... Question: An 18-year-old male high school student who had a 4-year history of diabetes mellitus was brought... An 18-year-old male high school student who had a 4-year history of diabetes mellitus was brought to the emergency department because of excessive drowsiness, vomiting, and diarrhea. His diabetes had been well controlled with 40 units of NPH insulin daily until several days ago when he developed excessive thirst and polyuria. For the past 3 days, he has also had headaches, myalgia, and a low-grade fever. Diarrhea and vomiting began 1 day ago. URINALYSIS RESULTS and CHEMISTRY TEST RESULTS

Specific gravity 1.012 Sodium 126 mmol/L

pH 5.0 Potassium 6.1 mmol/L

Glucose 4+ Chloride 87 mmol/L

Ketone Large Bicarbonate 6 mmol/L

Plasma glucose 600 mg/dL

BUN 48 mg/dL

Creatinine 2.0 mg/dL

Serum ketones 4+

Questions 1. What is the probable diagnosis of this patient based on the data presented?

2. What laboratory test(s) should be performed to follow this patient and aid in adjusting insulin levels?

3. Why are the urine ketones positive?

4. What methods are used to quantitate urine ketones? Which ketone(s) do they detect?

Answer 1

Answer:-1.Based on the data presented the diagnosis is patient is suffering from Diabetic ketoacidosis. Decreased insulin level and increased blood sugar levels.

Answer 2:- Laboratory test performed to this type of patient is blood sugar test to check blood sugar levels and blood acidity and ketone test or urine tests are performed. Sub cutaneous long-acting insulin (eg, insulin glargine, Detemir) should be initiated at the dose that was used earlier that is 40 units till the patient get stable.

Answer 3:- Ketone bodies are usually absent in urine. The presence of ketones in the urine probably indicates that the body is using fats rather than carbohydrates for energy.The presence of ketonesin these situations is due inadequate intake of carbohydrates or increased loss of carbohydrates.

Answer 4:- Rothera's test for ketone bodies in urine.

Sodium nitroprusside test for ketones.

Type of ketone bodies detected are acetoacetic acid and acetone .