Clinical history: Jose, a 43 year old Hispanic man with a long history of obesity and type 2 diabetics of recent, require daily insulin. His daughter brought him to emergency room early in the morning because he was confused, breathing rapidly and having to urinate than normal. He's having acid attack, he's has not been careful about his diet, night before, ate pizza and ice cream and lots of beer, and went to sleep without taking insulin.

 

physical examination & data: vital signs included temperature 39 C (102.2 F) heart rate 96 beats per min, and BP 90/60. Respiration was fast and hard, and his breath had an unusual 'paint thinner or nail polish remover ' odor. He was 5ft 9 in tall ands weighed 285 lb. he was drowsy and confused about time and place. Lab test reveals abnormal high blood glucose and low blood pH. His urineqas also unusual acidic and contains large amounts of glucose and ketone bodies, neither of which should normally be present. He had high blood osmolarity, low blood bicarbonate, and low blood partial pressure of CO2. His urine had high specific gravity.

 

Clinical course: the emergency room physician diagnosis of ketoacidosis and admitted him to the hospital. He was given insulin and large volumes of intravenous electrolytes solution containing bicarbonate. Further study fails to find infection or any other underlying cause of his fever. Within 24hrs, he was doing better, and discharged on third day.

 

Questions:

1. jose blood volume is decreased and his osmolarity increased. How will these changes affect ANP, ATII, Aldosterone, and ADH productions?
2. he was administered intravenous bicarbonate. Would this medical intervention have increased or decrease the production of carbonic acid, and what would have been the effect on his blood pH?
3. He is a type 2 diabetic. What is the problem here and what is the significance of insulin to him?
4. Alcohol inhibit ADH production. Remember that he drank too much beer in the night before. Would you expect his urine to be more concentrated or less concentrated than normal, simply as a result of his alcohol consumption?
5. would a cortisol injection worsen or improve his elevated blood glucose?

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Status NEW Posted 13 May 2017 02:05 AM My Price 8.00

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