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Clinical presentation case study

TA, 18 -year-old farmer Presented to her doctor with a months history of passing more urine than usual She was thirsty Lost weight Her doctor organised some tests but 2/7 later she was rushed to the MEU complaining of fever, breathlessness, drowsiness and vomiting

Ketoacidosis clinical presentation

Drowsy Over breathing

Dehydrated Hypotension

Gastric splash

Ketoacidosis lab investigations

Test Blood analysis Blood glucose Arterial pH PaO2 PaCO2 Urine analysis Urinary glucose Urinary ketones Potassium ++++ Large 6.0mmol/l 26.8mmol/l 7.1 15kpa 2.5kpa 7.35-7.45 10.0-13.3 4.7-6.0 Result Normal range

Lab investigations
Urea & creatinine, electrolytes Full blood count CXR

ECG Blood & urine cultures Take swabs from other sites as indicated

What has caused the increase in blood glucose level? Insulin deficiency from autoimmune destruction of pancreatic islets (insulin producing cells) 1. What has led to the acidaemia? Production of acidic chemical substances-ketone bodies ,frm fatty acid oxidation.

What are ketone bodies? How and why are they produced in this patient? (Acetacetic acid, B-hydroxybutyric acid,acetone) ketones are metabolic end product of fatty acid oxidation.Lipids are broken down to fatty acids and transported to the liver .Excess fattyacids will form acetyl coA which will then form ketones. Fatty acids and

Why did the patient present with thirst and polyuria 2. Hyperglycemia leading to osmotic diuresis and polyuria,the osmoreceptors in the hypothalamus sense this and relay signals to the brain and this is interpreted as thirst 3. What has caused the weight loss? Ans:Unrestrained lipolysis and proteolysis