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nausea and vomiting. She also has frequent urination but no hematuria nor dysruia. She is
disoriented and holds a can for vomiting, and has acetone smell.
What is metabolic acidosis?
Metabolic acidosis: clinical disturbance characterized by an increase in plasma acidity; due to
increased acid production, loss of bicarbonate, and a reduced ability of the kidneys to excrete
excess acids
When you have diabetes and don't get enough insulin and get dehydrated, your body burns fat
instead of carbs as fuel. Breaking down fatty acids produces ketones, which can make your
blood acidic. (diabetic ketoacidosis/ DKA)
*As blood pH drops (becomes more acidic), the parts of the brain that regulate breathing are
*The kidneys also try to compensate by excreting more acid in the urine, which in turn
facilitates the excretion of acid and partially restore systemic acid-base balance.
Elevated levels of blood glucose and ketone bodies are the hallmarks of untreated T1D.
Diabetic ketoacidosis (DKA), a type of metabolic acidosis, occurs in T1D. DKA is treated by
replacing fluid and electrolytes and administering short-acting insulin to gradually correct
hyperglycemia without precipitating hypoglycemia
*Nausea *Vomiting *Abdominal pain *A sweet, fruity smell on your breath *Weight loss.
The pancreas
The pancreatic juice has a pH of 8.0- 8.3, and the pH of liver bile is 7.8
pancreatic islets — the islets of Langerhans— secrete the hormones glucagon, insulin,
somatostatin, and pancreatic polypeptide (PP)
Pancreas endocrine function involves the secretion of insulin, and glucagon; that regulate the
*The alpha cell produces the hormone glucagon and makes up approximately 20 percent of
each islet. Low blood glucose levels stimulate the release of glucagon.
*The beta cell produces the hormone insulin and makes up approximately 75 percent of each
islet. Elevated blood glucose levels stimulate the release of insulin.
*The delta cell accounts for four percent of the islet cells and secretes the peptide hormone
somatostatin. Which is also released by the hypothalamus, stomach and intestines. An
inhibiting hormone that inhibits the release of both glucagon and insulin.
*The pancreatic polypeptide cell (PP cell) accounts for about one percent of islet cells and
secretes the pancreatic polypeptide hormone. It plays a role in appetite, and in the regulation
of pancreatic exocrine and endocrine secretions.
Vomiting:
tract rids itself of its contents when almost any part of the
upper tract becomes excessively irritated, overdistended, or even overexcitable. Excessive
distention or irritation of the duodenum provides an especially strong stimulus for vomiting.
The sensory signals that initiate vomiting originate mainly from the pharynx, esophagus,
stomach, and upper portions of the small intestines. And the nerve impulses are transmitted by
both vagal and sympathetic afferent nerve fibers to the vomiting center. From here, motor
impulses that cause the actual vomiting are transmitted from the vomiting center by way of
the:
1. fifth, seventh, ninth, tenth, and twelfth cranial nerves to the upper gastrointestinal
tract,
begins to occur often many minutes before vomiting appears. (Antiperistalsis: peristalsis up
the digestive tract rather than downward)
Vomiting Act.
Once the vomiting center has been sufficiently stimulated and the vomiting act instituted, the
first effects are
1. a deep breath,
2. raising of the hyoid bone and larynx to pull the upper esophageal sphincter open,
3. closing of the glottis to prevent vomitus flow into the lungs, and
4. lifting of the soft palate to close the posterior nares. Next comes a strong downward
contraction of the diaphragm along with simultaneous contraction of all the abdominal
wall muscles. This squeezes the stomach between the diaphragm and the abdominal
Thus, the vomiting act results from a squeezing action of the muscles of the abdomen
associated with simultaneous contraction of the stomach wall and opening of the esophageal
sphincters so that the gastric contents can be expelled.
Diabetes
leading cause of adult blindness and amputation and a major cause of renal failure, nerve
damage, heart attacks, and strokes.
-Gestational diabetes is a condition in which blood sugar levels become high during pregnancy
-Diabetes insipidus (DI) is a condition characterized by large amounts of dilute urine and
increased thirst. The amount of urine produced can be nearly 20 liters per day. Reduction of
fluid has little effect on the concentration of the urine. Complications may include dehydration
or seizures.
Type 1 diabetes:
cells of the pancreas. In T1D, the islets of Langerhans become infiltrated with activated T
lymphocytes, leading to a condition called insulitis. Over a period of years, this autoimmune
attack on the β cells leads to gradual depletion of the β-cell population, symptoms appear
abruptly when 80%– 90% of the β cells have been destroyed. At this point, the pancreas fails to
The onset of T1D is typically during childhood or puberty, and symptoms develop suddenly.
Patients with T1D can usually be recognized by the abrupt appearance of polyuria (frequent
urination), polydipsia (excessive thirst), and polyphagia (excessive hunger). These symptoms
hyperglycemia
When blood glucose is greater than 180 mg/dl, the ability of the kidneys to reclaim glucose is
impaired. This results in glucose spilling into the urine. The loss of glucose is accompanied by
the loss of water, resulting in the characteristic polyuria (and dehydration) and polydipsia in
diabetics.
The metabolic abnormalities of T1D mellitus result from a deficiency of insulin that profoundly
glucose before age 8 years because of the risk that episodes of hypoglycemia may adversely
Type 2 Diabetes:
Obesity is the most common cause of insulin resistance and T2D, Insulin resistance increases
with weight gain and decreases with weight loss, and excess adipose tissue is key in the
development of insulin resistance, With obesity, there are changes in adipose secretions that
result in insulin resistance. In the long-term, FFAs suppress glucose-induced insulin release.
With time β cell becomes increasingly dysfunctional and fails to secrete enough insulin to
correct the prevailing hyperglycemia.
Hyperglycemia:
is caused by increased hepatic production of glucose, diminished peripheral use. Ketosis is
usually minimal or absent in patients with T2D because the presence of insulin, even in the
Dyslipidemia:
Because lipoprotein degradation catalyzed by lipoprotein lipase in adipose tissue is low in
diabetics, the plasma chylomicron and VLDL levels are elevated, resulting in
hypertriacylglycerolemia
treating T2D is to maintain blood glucose concentrations within normal limits and to prevent
the development of long-term complications
Alpha-glucosidase inhibitors
These medications help your body break down starchy foods and table sugar. This effect
Biguanides
Biguanides decrease how much sugar your liver makes. The most common biguanide is
metformin.
glucose uptake into muscle cells and adipocytes:
Glucose cannot diffuse directly into cells but enters by one of two transport mechanisms: a
Na+-independent, facilitated diffusion transport system or an ATP-dependent Na+-
DEGRADATION OF GLYCOGEN (GLYCOGENOLYSIS);
1. Shortening of chains
2. Removal of branches
Glycolysis;
1. Phosphorylation of glucose
phosphoglucose isomerase
8. Dehydration of 2-phosphoglycerat
9. Formation of pyruvate, producing ATP
gluconeogenesis;
3. Phosphoenolpyruvate carboxykinase
phosphoenolpyruvate.
of glycolysis.
to glucose-6-phosphate.
6. Glucose-6-phosphatase converts
beta-oxidation
Ketone bodies;
produced using acetyl-CoA derived from fatty acid β-oxidation in the liver under specific
metabolic conditions. The two ketone bodies are acetoacetate and β-hydroxybutyrat
Eating a healthy diet with plenty of fruit and vegetables, maintaining a healthy weight, and
getting regular physical activity can all help maintaining normal levels of blood glucose
1. Keep track of your blood sugar levels to see what makes them go up or down.
3. Choose foods lower in calories, saturated fat, trans fat, sugar, and salt.
4. Track your food, drink, and physical activity.
8. Control your food portions (for example, use the plate method: fill half your plate with
non-starchy vegetables, a quarter with lean protein, and a quarter with a grain or
starchy food).
Maintaining normal blood sugar levels is a very important part of avoiding long-term health
issues, managing your weight and just feeling good. Health problems related to blood sugar
imbalances are a rapidly growing
To avoid;
Glucagon;
response is known as glycogenolysis. The glucose is then released into the circulation
3. Glucagon stimulates lipolysis, the breakdown of stored triglycerides into free fatty
acids and glycerol. Some of the free glycerol released into the bloodstream travels to the
liver, which converts the glycerol into glucose. This is also a form of gluconeogenesis.
Taken together, these actions increase blood glucose levels. The activity of glucagon is
regulated through a negative feedback mechanism; rising blood glucose levels inhibit further
glucagon production and secretion.
Insulin;
absorption occurs, the resulting surge in blood glucose levels further stimulates insulin
secretion.
Insulin is composed of 51 amino acids arranged in two polypeptide chains, designated A (21
amino acids) and B (30 amino acids), which are linked together by two disulfide bridges. The
insulin molecule also contains an intramolecular disulfide bridge between amino acid residues
of the A chain.
Insulin is degraded by insulin-degrading enzyme, which is present in the liver and, kidneys.
Insulin has a plasma half- life of approximately 6 minutes. This short duration of action
permits rapid changes in circulating levels of the hormone.
Insulin secretion by the pancreatic β cells is closely coordinated with the release of glucagon
by pancreatic α cells. The relative amounts of insulin and glucagon released by the pancreas
are regulated so that the rate of hepatic glucose production is kept equal to the use of glucose
by peripheral tissues
peptide hormones
2. Inhibition of insulin secretion: The synthesis and release of insulin are decreased when
there is a scarcity of dietary fuels and also during periods of physiologic stress (for
other tissues have insulin-insensitive systems for glucose transport. For example, hepatocytes;
erythrocytes; and cells of the nervous system, intestinal mucosa, renal tubules, and cornea do
not require insulin for glucose uptake
Buffers;
A buffer is a system of molecules and ions that acts to prevent changes in H + concentration
and thus serves to stabilize the pH of a solution. In blood plasma, the pH is stabilized by
reversible reaction involving the bicarbonate ion (HCO 3 – ) and carbonic acid (H 2 CO 3 ):
The double arrows indicate that the reaction could go either to the right or to the left; the net
direction depends on the concentration of molecules and ions on each side. If an acid (such as
lactic acid) should release H + into the solution, the increased concentration of H + would drive
the equilibrium to the right and the following reaction would be promoted:
prevented from rising (and the pH prevented from falling) by the action of bicarbonate buffer.
osmotic diuresis;
osmotic diuresis is increased urination due to the presence of certain substances in the fluid
filtered by the kidneys. This fluid eventually becomes urine. These substances cause additional
water to come into the urine, increasing its amount.
Transport maximum for glucose is expressed by the maximum transporting capacity of the
SGLT transportation system. Excessive glucose is not reabsorbed and consequently passes into
urine. Transport maximum for glucose tubular transport system in adult humans is about 375
mg/min.
Na + and K + levels in plasma;
Potassium
In hypokalemia, the level of potassium in blood is too low. A low potassium level usually results
from vomiting, diarrhea, adrenal gland disorders, or use of diuretics. A low potassium level
can make muscles feel weak, cramp, twitch, or even become paralyzed, and abnormal heart
rhythms may develop.
Potassium affects the way the heart's muscles work. When there is hyperkalemia; too much
potassium, the heart may beat irregularly, which may cause heart attacks.
Sodium
hyponatremia can include altered personality, lethargy and confusion, seizures, coma and
even death.
1. changing a medication that affects your sodium level, treating the underlying disease,
changing the amount of water you drink or changing the amount of salt in your diet.
2. Intravenous fluids, IV sodium solution to slowly raise the sodium levels in your blood.
People with diabetes are advised to limit sodium, to prevent or control high blood pressure
Hyponatremia can result from multiple diseases that affect the lungs, liver, brain, or heart
problems like congestive heart failure. the amount of sodium you consume can worsen your
condition by causing hypertension (high blood pressure).
function by impairing calcium homeostasis and thereby alters aspects of platelet activation
and aggregation, including platelet conformation and release of mediators.
1. Peripheral artery disease, known as PAD, occurs when plaque builds up in the arteries
disease. The tiny blood vessels in the retina become swollen, which blocks the oxygen
supply to the retina. If the condition becomes severe, it can cause blindness.
The endocrine system;
series of glands that produce and secrete hormones that the body uses for a wide range of
functions. These control many different bodily functions, including:
1. Respiration
2. Metabolism
3. Reproduction
4. Sensory perception
5. Movement
6. Sexual development
7. Growth
Hormone- producing glands are;
1. Hypothalamus: responsible for body temperature, hunger, moods and the release of
hormones from other glands; also controls thirst, sleep and sex drive. Hormones of the
Hypothalamus
*Thyrotropin-releasing hormone (TRH) *Gonadotropin-releasing hormone (GnRH) *Growth
hormone-releasing hormone (GHRH) *Corticotropin-releasing hormone (CRH) *Somatostatin
*Dopamine.
2. Pituitary: master control gland, the pituitary gland controls other glands and makes
the hormones that trigger growth. Hormones produced by the pituitary gland
*Adrenocorticotrophic hormone (ACTH) *Thyroid-stimulating hormone (TSH) *Luteinising
hormone (LH) *Follicle-stimulating hormone (FSH) *Prolactin (PRL) *Growth hormone (GH)
*Melanocyte-stimulating hormone (MSH)
3. Parathyroid: controls the amount of calcium in the body. produces the *parathyroid
hormone, which plays a role in regulating your body's levels of the minerals calcium
and phosphorus. Hyperparathyroidism is when your parathyroid glands create too
much parathyroid hormone in the bloodstream
4. Pancreas: This gland produces the insulin that helps control blood sugar levels.
*insulin, *somatostatin, *gastrin, and *glucagon, play an important role in maintaining
sugar and salt balance in our bodies
5. Thyroid : The thyroid produces hormones associated with calorie burning and heart
rate. *triiodothyronine (T3) and *thyroxine (T4). It also stores these thyroid hormones
and releases them as they are needed.
6. Adrenal : produce the hormones that control sex drive and cortisol, the stress hormone.
* Cortisol *Aldosterone *DHEA *Androgenic Steroids *epinephrine (adrenaline)
*norepinephrine (noradrenaline)
7. Pineal: This gland produces *melatonin which affects sleep.
8. Ovaries: Only in women, the ovaries secrete *estrogen, *testosterone and
*progesterone, the female sex hormones.
9. Testes:Only in men, the testes produce the male sex hormone, *testosterone, and
produce *sperm.
Laboratory findings explanaition;
Sodium:
helps keep the water and electrolyte balance of the body
Complications of hyponatremia include altered personality, lethargy and confusion. Severe
hyponatremia can cause seizures, coma and even death.
Hypernatrenia can lead to high blood pressure, heart disease, and stroke. It can also cause
calcium loss.
Potassium:
helps the nerves to function and muscles to contract and helps the heartbeat stay regular.
If left untreated, both severe hypokalemia and severe hyperkalemia can lead to paralysis,
cardiac arrhythmias, and cardiac arrest.
mild cases of hyperkalemia may not produce symptoms and may be easy to treat, but severe
cases that are left untreated can lead to fatal cardiac arrhythmias.
Hyperkalemia, hads a higher risk of morbidity and mortality if left untreated. Severe
hypokalemia may also cause respiratory failure, constipation and ileus( lack of movement
somewhere in the intestines that leads to a buildup and potential blockage of food material.)
Chloride:
helps keep the amount of fluid inside and outside of the cells in balance. It also helps maintain
proper blood volume, blood pressure, and pH of body fluids.
Hypochloremia is an electrolyte imbalance that occurs when there's a low amount of chloride
in your body. Symptoms include: fluid loss. Dehydration. weakness or fatigue. difficulty
breathing. diarrhea or vomiting, caused by fluid loss.
Hyperchloremia complications include: excessive fatigue, muscle weakness, breathing
problems, frequent vomiting, prolonged diarrhea, excessive thirst, high blood pressure.
Bicarbonate :
help maintain the acid-base balance (pH) and to work with sodium, potassium, and chloride to
maintain electrical neutrality at the cellular level.
A low CO2 level can be a sign of several conditions, including: Kidney disease. Diabetic
ketoacidosis
Low bicarbonate levels in the blood are a sign of metabolic acidosis.
1. Long and deep breaths.
2. Fast heartbeat.
3. Headache and/or confusion.
4. Weakness.
5. Feeling very tired.
6. Vomiting and/or feeling sick to your stomach (nausea)
7. Loss of appetite.
High bicarbonate levels may cause:
1. Confusion (can progress to stupor or coma)
2. Hand tremor.
3. Lightheadedness.
4. Muscle twitching.
5. Nausea, vomiting.
6. Numbness or tingling in the face, hands, or feet.
7. Prolonged muscle spasms (tetany)
Urea :
Urea is made when protein is broken down in your body. Urea is made in the liver and passed
out of your body in the urine, high urea in the blood indicates kidney dysfunction.
Low urea levels are not common and are not usually a cause for concern. They can be seen in
severe liver disease
creatinine :
1. Nausea.
2. Chest Pain.
3. Muscle Cramps.
4. Vomiting.
5. Fatigue.
6. Changes in urination frequency and appearance.
7. High blood pressure.
8. Swelling or fluid retention
Low muscle mass: Lack of strength, difficulty exercising, a thin or frail body. Liver disease:
Inflamed liver, which may cause pain in the upper right-side of the abdomen, fatigue or
nausea. Diet-related: Feeling faint or dizzy, losing weight.
Glucose:
Hyperglycemia can damage the vessels that supply blood to vital organs, which can increase
the risk of heart disease and stroke, kidney disease, vision problems, and nerve problems.