Question

A 12-year-old girl who has been losing weight comes to the doctor, her mother tells the physician that the daughter is always hungry. The mother is sure there is a kidney problem, because her daughter is getting up twice each night to go to the bathroom.

Respiration : 15/min                                        ph:7.35                                             urine ph :5

Blood pressuere:125/80                                WBC: 8200/mm3                          urine glucose:1000mg/gl

Pulse:75                                                               blood glucose:260mm/gl          urine ketones: large

Temperature:37c                                             Albumin:4.0g/l                              urine specific gravity:1,006

1. Why is patient always hungry if she is eating well? Discuss anatomy and physiology
2. Why is getting up to go to the bathroom every night?
3. Give a possible diagnosis
4. What further studies or tests would the doctor likely recommend?

Answer 1

1. In case of increased serum glucose levels in the lack of insulin, the glucose does not enters into the cell. This leads to a depletion in energy resources within the cell which restricts ATP production. This causes the cell to initiate response to send impulse to the hunger Center within the brain in lack of energy causing increased hunger, despite eating well. There is increased lipolysis, which increases FFA and causes production if ketone bodies. The basic anatomy and physiology involve decreased uptake of glucose leading to initiation if hunger control reflexes.
2. The subject is having glycosuria. As the glucose level in the urine increases, it causes the osmotic movement of water into the renal tubules. This causes an increase in urine production causing symptoms of polyuria.
3. Possible diagnosis referring to the symptoms as polyuria, polydypsia, and polyphasic along with increased serum and glucose concentration includes DIABETES MELLITUS.
4. The doctor should order complete urine routine examination along with blood glucose monitoring with oral glucose tolerance test and specific test like HBA1c for making the diagnosis and providing medications and treatment accordingly.