Mr. Gutteman, a 70-year-old male, was brought into the ER. He had been sick several days with the flu, and was found confused and barely conscious by his daughter. Mr. Gutteman is breathing rapidly and has a fever of 39°C (102°F). His skin is dry and flaccid, his mucous membranes are dry, and his eyes are sunken. The physician ordered: • IV (intravenous) fluid and electrolyte replacement • Blood and urine tests for presence of glucose and ketones • Strict I&O [careful measurement of fluid intake (e.g., IV, drinking) and output (e.g., urine)] 1. You would expect high levels of blood glucose and the presence of glucose and ketones in Mr. Gutteman's urine if: a. His pancreas is secreting too much insulin b. His liver is secreting too little insulin c. His pancreas is secreting too little insulin d. His liver is secreting too much glucagon Mr. Gutteman's blood and urine tests are negative for glucose and ketones. However, Mr. Gutteman is losing large amounts of water in urine, and the volume lost is being replaced (via IV). 2. Given this new information, Mr. Gutteman's excessive fluid loss in his urine most likely indicates: a. An increased blood level of aldosterone b. A decreased blood level of antidiuretic hormone c. An increased blood level of antidiuretic hormone d. A decreased blood level of insulin 3. Mr. Gutteman's diagnosis is diabetes insipidus. His daughter is concerned about this, because she knows diabetes is a dangerous disease. She asks whether he will have to follow a diabetic diet. • What's your answer? 4. Is diabetes insipidus life threatening? Explain your answer.
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You would expect high levels of blood glucose and the presence of glucose and ketones in Mr.Gutteman's urine if: a. His pancreas is secreting too much insulin b. His liver is secreting too little insulin c. His pancreas is secreting too little insulin d. His Show more…
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Thomas L., a 28-year-old male, complained of abrupt polydipsia (excessive thirst) and polyuria (excessive urine volume). Blood and urine analyses provided the following results: Blood Tests: - Fasting blood glucose: 93 mg/dL (normal is 65-100 mg/dL) - Serum sodium: 145 mmol/L (normal is 135-145 mmol/L) - Serum potassium: 2.8 mEq/L (normal is 3.5-5 mmol/L) Urinalysis: - Urine osmolarity: <200 mOsm/L (much more dilute than normal) - Urine volume: 15 L/day (normal is 2-3 liters/day) - Urine glucose: 0 (normal is 0) Water deprivation and hypertonic saline infusion did not cause a significant reduction in the polyuria, nor did the urine become more concentrated. Complete water deprivation resulted in a urine osmolarity of 225 mOsm/L. Following administration of exogenous ADH, there was a significant concentration of the urine and a decrease in urinary output. 1. Is Thomas hypoglycemic? 2. To maintain a steady state, how much water must Thomas drink per day? 3a. Why was water deprivation and hypertonic saline infusion ordered? 3b. How would a normal healthy person respond to these tests? Think of how urine volume and concentration would be affected. 4. Why did the water deprivation and hypertonic saline infusion not result in a concentrated urine? 5. Are Thomas's kidneys capable of responding to ADH? What is the evidence?
Adi S.
E.B. is a 51-year-old man who presents to the ER with a 2-week history of polyuria, polydipsia, polyphagia, weight loss, fatigue, and blurred vision. A random glucose test performed 1 day before presentation was 352 mg/dl. The patient denied any symptoms of numbness, tingling in hands or feet, dysuria, chest pain, cough, or fevers. He had no prior history of diabetes and no family history of diabetes. Admission non-fasting serum glucose 248 mg/dl (N=<180 mg/dl), HbA1c 9.6% (N=4-6.1%). Electrolytes, BUN, and creatinine were normal. Physical examination revealed a weight of 180 pounds, height 5'5.5" (IBW 140-145). The rest of the examination was unremarkable, i.e., no signs of retinopathy or neuropathy. The patient was taught self-monitoring of blood glucose and begun on 5 mg glyburide once a day. He was instructed in a diet (1800 cal ADA). Blood glucose levels ranged from 80 to 120 mg/dl within 2 weeks of starting glyburide, his symptoms disappeared, and weight remained constant. During the next two months, blood glucose levels decreased to 80 mg/dl, and glyburide was stopped. The patient did not return until one year later; fasting serum glucose was 190 mg/dl, and HbA1c 8%. He again had polyuria and nocturia. Weight was unchanged from the time of presentation. The physician put him on 5 mg/day of glyburide. His blood sugar one month later remained at 180 mg/dl. At this point, his physician decided to put him on insulin alone, 20 units/day at bedtime. Two weeks later, his fasting plasma glucose was 120 mg/dl.
Shaiju T.
Case Study: Type 1 Diabetes Mellitus (DM1) David Mandel was diagnosed with type 1 (insulin-dependent) diabetes mellitus when he was 12 years old. He was in middle school at that time. He was a very good student and had many friends. At a sleepover party, the unimaginable happened – David wet his sleeping bag! He was embarrassed and might not have told his parents except that he was worried about other symptoms he was having. He was constantly thirsty and was urinating every half hour or so. Furthermore, despite a voracious appetite, he seemed to be losing weight – all of his pants had become loose in the waist. His friends remarked that his breath smelled funny. David’s parents panicked because they knew that these were classic symptoms of diabetes mellitus. They took David to see his pediatrician who performed a physical examination and ordered laboratory tests. RESULTS: Height: 5ft 3in Weight: 100 lb (previous visit 2 months earlier he was 108 lbs) Blood pressure: 90/55 (supine); 75/45 (standing) Fasting plasma glucose: 320 mg/dL (normal: 70-110 mg/dL) Plasma ketones: 1+ (normal: none) Urinary glucose: 4+ (normal: none) Urinary ketones: 2+ (normal: none) The findings were consistent with a diagnosis of type 1 (insulin-dependent) diabetes mellitus. David immediately started taking injectable insulin and learned how to monitor his blood glucose level with a finger stick. His mother modified his diet to increase protein intake and decrease carbohydrates. He continued to excel in high school and is currently in the pre-medical program with the goal of a career in pediatric endocrinology. He has periodic checkups with his endocrinologist, who emphasizes the importance of meticulous care of the feet, checks for cataracts, and monitors his renal function.
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