Question

Susan, 28-year young woman with type-1 diabetes mellitus has developed viral gastroenteritis. She is vomiting and feels very nauseous. She did not take her insulin and is increasingly becoming non-responsive. When she arrives at the ER, her pulse is 128 and her respiratory rate is 28, deep, and smells fruity. Her urinary glucose and ketones are very high. Her pH was dangerously low. Describe her symptoms in relation to type 1 diabetes. Explain how the kidney attempted to compensate for the low pH.

Thank you in advance :D

Answer 1

In this case,symptoms of Susan is due to Diabetic ketoacidosis.

Type 1 Daibetes - chronic condition where pancreas produces little or no insulin.

Role of Insulin:Increasing glucose uptake in muscle and adipose tissue by increasing the number of plasma membrane GLUT1 and GLUT4.

In patients with diabetes,when Insulin is Administered,They enhance uptake of Glucose by muscles and tissues for energy.In the Absence of insulin,Glucose uptake by muscles and tissues are hindered.In the absence of Glucose our body begins to break down fat as fuel.This process leads to formation and Build up of Ketones(  water-soluble compounds produced in the Liver as byproducts when the body burns fat for energy.

This build of Ketone Bodies in your Blood Causes Diabetc ketoacidosis.

the Ketone Bodies have Fruity Smell detected in the breath of persons in ketoacidosis.

In response to Ketoacidosis,Our body tries to compensate for the low ph Initially by Increased ventilation where there is Removal of more CO2 from the body.So there is a charecteristic respiration pattern called kussmuals respiration-Charecterised by Rapid Deep Breath with fruit order.Being water soluble,they are excreated in the urine when concentration of ketone bodies are very high.

Also  Hyperglycemia causes osmotic diuresis and tachycardia.

Kidney and Lungs plays key role in maintaing Acid base Balance

Kidney control acid base balance mainly by its effect on Secreation of H+ into Filtrate

The Kidney compensation for acidosis(Low ph) is by-

1.Excreting acidic urine-Renal secreation(excretion) of H+ is enhanced which reduces H+ concentration in blood and Increases pH.

2.Conserving (Reabsorbtion)of HCO3-