Question

Tonya, a 20-year-old woman, was brought to the hospital ER in a comatose state. Her roommate states she had been nauseated earlier in the day. Upon examination, it was noted that the patient was breathing deeply and rapidly. Her breath had a fruity odor, and mucous membranes were dry. Family members contacted stated that the woman's older brother had Type I diabetes. Laboratory results: Na+ 128 mmol/L K+ 5.7 mmol/L Cl- 88 mmol/L HCO3- 9 mmol/L BUN 50 mg/dL Serum Osmolality 310 mOsm/kg pH 7.12 pCO2 28 mm Hg Serum glucose 780 mg/dL Urine glucose 4+ Serum acetone 3+ Hgb 17.6 g/dL HCT 53% WBC 12,000 RBC 6.0 million Differential normal Questions: a. Identify abnormal lab values (15) b. On the basis of the patient's history and laboratory results, what would likely be Tonya's problem? c. Which of the lab findings is most valuable in establishing the fact she could have diabetic ketoacidosis? d. What are the three major ketone bodies? e. The nitroprusside chemical reaction may be used to indicate a positive serum acetone reacts with which chemical compound? f. Would insulin levels be increased, decreased, or normal in this patient? Why? g. Why does the patient exhibit glycosuria? h. After discharge with an insulin regimen, what laboratory procedure would be of most value in determining the glucose control over a period of time?

          Tonya, a 20-year-old woman, was brought to the hospital ER in a comatose state. Her roommate states she had been nauseated earlier in the day. Upon examination, it was noted that the patient was breathing deeply and rapidly. Her breath had a fruity odor, and mucous membranes were dry. Family members contacted stated that the woman's older brother had Type I diabetes.

Laboratory results:
Na+ 128 mmol/L
K+ 5.7 mmol/L
Cl- 88 mmol/L
HCO3- 9 mmol/L
BUN 50 mg/dL
Serum Osmolality 310 mOsm/kg
pH 7.12
pCO2 28 mm Hg
Serum glucose 780 mg/dL
Urine glucose 4+
Serum acetone 3+
Hgb 17.6 g/dL
HCT 53%
WBC 12,000
RBC 6.0 million
Differential normal

Questions:
a. Identify abnormal lab values (15)
b. On the basis of the patient's history and laboratory results, what would likely be Tonya's problem?
c. Which of the lab findings is most valuable in establishing the fact she could have diabetic ketoacidosis?
d. What are the three major ketone bodies?
e. The nitroprusside chemical reaction may be used to indicate a positive serum acetone reacts with which chemical compound?
f. Would insulin levels be increased, decreased, or normal in this patient? Why?
g. Why does the patient exhibit glycosuria?
h. After discharge with an insulin regimen, what laboratory procedure would be of most value in determining the glucose control over a period of time?

Added by Michael L.

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