AnnasCauseofDeath

CauseofDeath:AnnaGarciadiedfromKetoacidosis.Ketoacidosisleadstodiabetic
coma,lackofglucosereachingcells,andfinallydeath.Whencellsinthebodydontget
enoughglucosetheyturntostoredfatforenergywhichproducekeytones.Keytonesarea
poisontothebody.

Timeline
14Months:Annawastakentothedoctorbecauseshewasexperiencingseverepain
andfever.Herheartwasoverworking,withaveryhighpulseat175bpm.Shewasurinating
morethanusual,andwasverylethargic.Annahadswellinginthehandsandfeet,shewas
experiencingtendernessinherabdomen,andwasenlargedontheleftsidewhichcouldbe
apossiblesignofsplenicsequestration.ACBCtestwasperformedandshowedlowred
bloodcellcountandahighwhitebloodcellcount.Herhematocritsawslowerthannormal.
HerbloodwaslowinoxygenandaCTscanshowedanabnormalityinherspleen,which
confirmedsplenicsequestration.ThisledthedoctortoperformasicklecelltestAnna
testedpositive.

TreatmentIVhydration,painmeds,redbloodcelltransfusion,antibioticstoprevent
infection

14yearsold:Annahasnoothermedicalproblemsexceptforsicklecellatthispoint.She
goestothedoctorwithcomplaintsoffatigueandnotbeingabletocompletehernormal
activities.Sheisalwaysthirstynomatterhowmuchshedrinks,andusesthebathroom
moreoftenthannormal.Shehaslostalmost10lbs.sinceherlastvisit,despitethefactthat
herdietandexerciseroutinehasntchanged.(exercisemayhavedecreaseddueto
fatigue)Shehasafamilyhistoryofhighcholesterolandheartdisease.Annawasnt
experiencinganyswellingorpain,andherspeech,hearingandvisionwerenormal.Her
CBCtestcamebacknormalandherroutineurinalysisshowedglucoseintheurine.Dueto
familyhistoryandglucosefoundinurine,Annawassentinforglucosetolerancetesting.

GTTAnnahadaquickincreasesinglucoseanditstayedhigh,whichtoldus
thatshehaddiabetes.ThelevelofinsulininAnnashowedusthatherbody
doesntproduceit.ThistoldusthatAnnahadtype1diabetes.

Annawasfatiguedbecausehercellswereunabletogettheenergytheyneeded.
Theincreasedbathroomuseandneversatisfyingthirstaresymptomsofdiabetes.
Annaisalsohyperglycemicbecausethecellsaredeprivedofwaterduetothe
waterleavingthecell.

37yearsold:Annawenttothedoctorbecauseoftwoincidentswhereshehad
selfresolvedchestpain.Herdietishighincaloriesandfatsandsheisoverweight.She
takesadailyaspirinanddoesYogaonceinawhile,buthasntkeptupwithdailyexercise.
Annahasafamilyhistoryofearlyheartdiseaseaswellasuncontrolledhypertension.Her
daddiedofaheartattackatage41.Annahashighbloodpressureandahighheartrate.
Annawasevaluatedbyadoctorwhoperformedaphysicalexam,cardiacstresstestwith
EKG,andanechocardiogram.ThephysicalexamshowedthatAnnaistachycardic,which
meansthatherrestingheartrateisbetween90and105whichishigh.Aslightheart
murmurwasalsodetected.ThetreadmillstresstestshowedthatAnnaexperienceda
drasticincreaseinbloodpressureaswellasafewPVCs.Mitralregurgitationwasnoted,
andAnnawasonlyabletowalkfor8minutesbeforethetestwasconcluded.Thesetests
ledtoanangiogramtoexplorethecardiacvessels.

Angiogramrevealedablockageintheleftanteriordescendingcoronary
artery.Angioplastyisrecommendedwiththepotentialforstenting.

DuetoAnnashighsystolicBP,shehasstage1hypertension.

37yearsold:Afullcholesterolpanelwasconductedinthelab.Annastotalcholesterol
wasEXTREMELYhighat389mg/dL(normallessthan200).HerLDLlevelswerealso
veryhighat243,andanormallevelbeinglessthan100.HerHDLlevelsandtriglycerides
weregood.Herfastingbloodsugarwasnormal,whichmeantshewaskeepingupwithher
diabetesandherhemoglobinA1cswereabithigh,butshehassicklecell,soitmakes
senseanditwasnttoohigh.Agelelectrophoresiswasperformedtohelpdeterminewho
inherfamilyhadhypercholesterolemia.Thishelpedthedoctorsfillinthepedigreeof
Annasfamilyandhelpdiagnoseher.

Annaneedstotakemedicationtohelplowerhercholesterol,andshealsoneedstostart
eatingahealthierdiet.Ifshedoesntdothesethingstheplaquebuildupinherarteries
couldcauseablockageandheartattackorstroke.

38yearsold:Annawassenttothehospitalforasicklecellcrisis.Shewastherefor5
daysandhadacatheterputinbecauseshewasunabletogetoutofbedduetothepain
shewasexperiencing.Herbloodpressureandheartratewereveryhighandshegained
moreweight.Shealsohadaf,whichwasmostlikelyduetothesicklecellcrisis.Aftershe
wenthomeshenoticedthatshefeltlikeshehadtourinateallofthetimebutonlyasmall
amountwouldcomeout.Thedoctorsentaurinesampletothelab.Theurinalysistested
positiveforabacterialinfection.Thegrossexaminationofcolonymorphologyshoweda
mediumsized,smooth,circular,convex,andredincolorbacteria.Thegramstaintest
showedagramnegativebacteriathatwascoccusshaped(round).Theentertubesystem
indicatethatthetypeofbacteriapresentwasSerratiamarcescens.

TreatmentAntibioticsandpainmeds

ContributingFactorstoAnnasDeath
UrinaryCertainillnessescancauseyourbodytoproducehigherlevelsofcertain
hormones.Thesehormonesactagainstinsulin.Urinarytractinfectionsarecommon
culprits.

ImmuneHighfevercantriggerketoacidosis

NervousStressandPhysicaloremotionaltrauma:Annawasunderstresswithherfamily
problemsandhavingtodealwithallofherdiseasesandtheirsideeffects.Cerebral
Edemaisacomplicationofketoacidosisswellingofthebrainduetoadjustingblood
sugarleveltoquickly

CardiacHeartdisease(heartattack)canincreasetheriskofketoacidosis,missed
insulindosescancausehighglucoselevelsandincreasetheriskofketoacidosis

Prevention
ManagediabetesEathealthyandexerciseeveryday.Takeinsulinasdirectedbydoctor.

MonitorbloodsugarlevelCheckthreeorfourtimesaday:moreifunderstressorsick

Adjustinsulindosageasneededtalktodoctorandmakesureyouaccountforallofthe
factors(diet,exercise,bloodsugarlevel,sickness)

CheckKetonelevelSickorunderstresscheckurineforketones:overthecounter
ketonetestkit.Ifitismoderateorhighcontactdoctor

Actquicklyifyoususpectthatyouhavediabeticketoacidosisseekemergencycare.