Question

Chief Complaint: 8-year-old girl with excessive thirst, frequent urination, and weight loss.

History: Cindy Mallon, an 8-year-old girl in previously good health, has noticed that, in the past month, she is increasingly thirsty. She gets up several times a night to urinate, and finds herself gulping down glassfuls of water. At the dinner table, she seems to be eating twice as much as she used to, yet she has lost 5 pounds in the past month. In the past three days, she has become nauseated, vomiting on three occasions, prompting a visit to her pediatrician.

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Questions

1. At the doctor's office, blood and urine samples are taken. The following lab results are noted:

blood glucose level = 545 mg/dl blood pH level = 7.23

(normal = 50 - 170 mg/dl) (normal = 7.35 - 7.45)

urine = tested positive for glucose and for acetone / acetoacetate (i.e. ketone bodies) (normally urine is free of glucose and ketone bodies) Question 1: How will the urinary system attempt to rectify Cindy’s decreased blood pH? Be specific. In her mid-forties, Cindy began to show early signs of diabetic nephropathy (kidney disease), consisting of persistent proteinuria, hypertension, and gradually decreasing renal function as measured by chemical tests. She nonetheless felt fairly healthy over the next 10 years. At age 55, however, she has noticed becoming increasingly fatigued upon mild physical exertion and requiring more sleep than previously. In addition, she has generally felt nauseated most of the time, and in the past two weeks, has vomited on several occasions. She has increased swelling in her ankles, and is short of breath. She has also become less responsive over the past day or so. Laboratory tests reveal that her kidney disease is now progressing at a much faster rate: BUN (blood urea nitrogen) = 56 mg / dl         (normal = 10 - 20 mg / dl) Urinary output = 25 cc / hour                         (normal = 50-60 cc / hour) Cindy is advised by her physician that her kidneys are failing. She is informed about treatment options: hemodialysis vs. continuous ambulatory peritoneal dialysis (CAPD) vs. kidney transplant. In consultation with her physician, Cindy chooses to undergo hemodialysis. A checkup two weeks after beginning dialysis reveals the BUN has decreased to 35 mg / dl. Although hemodialysis is fairly effective, it is not fool-proof. For example, patients with chronic renal failure, despite a regular schedule of hemodialysis, will experience disruptions in calcium and phosphate balance. Question 2: How might the endocrine system compensate for the change in blood calcium levels?

Answer 1

Question no 1

Cindy maron is having type 1 diabetes and associated ketoacidosis which is a metabolic condition. This is relived by the compensation of Kidney by specifically they will increase the hco3- level in body so that the pH of blood will increase to a normal range . This take place by the excretion of H+ ions from blood and retention of HCO3 in exchange for it . This will cause significant increase in pH

Question no 2

When the disruption in Calcium takes place in body our body will respond by

Body will increase the level of parathyroid hormone and calcitriol as well as the growth hormone by pitutary to increase the blood Calcium level .

Hypothalamus stimulate the production of growth hormone by secretion growth hormone stimulating hormone ,this inturn activate the pitutary to secrete the growth hormone and increase pH

The secretion of calcitriol from kidney ( if present as Kidney failure is progressing) then if will lead to increase in absorption of calcium from intestine

The parathyroid hormone from parathyroid glands will lead to increase in the osteoclast activity and cause resorption if bone and increase blood Calcium level

And if increase in Calcium occur then

Then body will stimulate the thyroid gland and secretion of calcitonin occur . Calcitonin is an osteoblasts activator that activate the accumulation and deposition of calcium into the bone and cause the reduction in blood Calcium

:)