Case Study

An 18-year-old male high school student who had a 4-year history of diabetes mellitus
was brought to the emergency department because of excessive drowsi- ness, vomiting,
and diarrhea. His diabetes had been well controlled with 40 units of NPH insulin daily
until several days ago when he developed exces- sive thirst and polyuria. For the past 3
days, he has also had headaches, myalgia, and a low-grade fever. Diarrhea and vomiting
began 1 day ago.

Specific Gravity 1.012

pH 5.0
Glucose 4+
Ketone Large

Urinalysis Result

Sodium 126 mmol/L

Potassium 6.1 mmol/L

Chloride 87 mmol/L

Bicarbonate 6 mmol/L

Plasma Glucose 600 mg/dL

BUN 48 mg/dL

Crea 2.0 mg/dL

Serum Ketones 4+

Chemistry Test Result

Questions;
1. What is the probable diagnosis of this patient based on the data presented?
Based on the table above, we can see that the glucose and ketones are high than the
average range, I might say that he has Type 1 diabetes or also called as the Insulin
Dependent Diabetes Mellitus because the glucose is high and there is a labelled “large” in
ketones.

2. What laboratory test(s) should be performed to follow this patient and aid in adjusting
insulin levels?
I will recommend to give him a regular check-up for laboratory tests especially in
urinalysis and blood test.

3. Why are the urine ketones positive?

Tissues are starved of glucose because of deficient insulin which leads to lipolysis in
body tissues. Metabolism of fats leads to production of fatty acids. Fatty acids undergo
transformation to ketoacidosis in the liver.

4. What methods are used to quantitate urine ketones? Which ketone(s) do they detect?
Quantitative reflectance data for the ketone reflectance field and compared it with
biochemical data from urine samples. Using an easy sample pre-treatment with 3-
hydroxybutyrate dehydrogenase.