PATHOPHYSIOLOGY OF DIABETES MELLITUS, CHRONIC KIDNEY DISEASE AND THEIR ASSOCIATED COMPLICATIONS

NON-MODIFIABLE FACTORS:
MODIFIABLE FACTORS:
 Family History
 Obesity (BMI >25kg/m2)
 Age
 Physical Inactivity
 Gender (Female)
 Stress
 Race (African American,
 Polycystic Ovary Syndrome
DESTRUCTION OF BETA CELLS IN Hispanic, Native American)
 Hypertension (>130/80
THE PANCREAS
mmHg)
 Alcoholism
 Diet
FAILURE TO PRODUCE
INSULIN/INSULIN RESISTANCE

BETA CELLS OF THE ISLETS OF LANGERHANS DECREASED INSULIN RELEASE FROM

CONTINUOUSLY RELEASE INSULIN THE ISLETS OF LANGERHANS

CBG RESULTS
ELEVATED BLOOD GLUCOSE 11/28: 435mg/dL
11/29: 465 mg/dL
11/30: 471, 416 mg/dL

INCREASED OSMOLARITY DUE DECREASED AM OUNT OF GLUCOSE CHRONIC ELEVATION OF BLOOD

TO GLUCOSE ABSORBED BY THE CELLS PRESSURE

FLUID SHIFTS FROM ICF TO ECF CELL STARVATION

STIMULATION OF OSMORECEPTORS STIMULATION OF THE HUNGER

OF THE HYPOHYPOTHALAMUS MECHANISM BY THE HYPOTHALAMUS

S/SX: POLYDIPSIA S/SX: POLYPHAGIA

FLUID INTAKE:

GLYCOPROTEIN CELL WALL

DEPOSITS
 ACCELERATED IMPAIRED IMMUNE
INTERFERENCE IN THE BLOOD DECREASED ATHEROSCLEROSIS FUNCTION
VESSEL’S ABILITY TO TRANSMIT ELASTICITY OF
NERVE IMPULSES
WEAKENING OF SMALL BLOOD
AUTONOMIC NEUROPATHY (DIABETIC NEUROPATHY) BLOOD VESSELS CAPILLARIES THICKENING OF BLOOD ENTRY OF S. AUREUS, HEMATOLOGY RESULT
VESSEL WALLS STREPTOCOCCUS 09/28 10/10
PNEUMONIAE, KLEBSIELLA
PNEUMONIAE NEUTROPH 0.83 0.71
S/Sx: S/Sx: ILS
S/Sx: DIFFICULTY IN BLOOD LYMPHOCY 0.09 0.15
 DYSPHAGIA  TINGLING OF FINGERS  BLURRED CIRCULATION
INITIATION OF TES
 ABDOMINAL PAIN  NUMBNESS VISION
 CONSTIPATION 
INFLAMMATORY RESPONSE Normal Values
 WASTING OF INTRINSIC BLINDNESS
 GASTROPARESIS MUSCLES (160/90, NEUTROPHILS: 0.43-0.65
INCREASED PRESSURE IN
 NEUROGENIC BLADDER LYMPHOCYTES: 0.20-0.40
BLOOD VESSELS ALVEOLAR EDEMA +
 VOMITING
EXUDATE FORMATION

CHEMISTRY RESULT S/Sx:

DECREASED GLOMERULAR ELEVATED B/P ALVEOLI & RESPI BRONCHIOLES
09/28 10/10 10/28 FILL WITH SEROUS EXUDATE
FILTRATION RATE (160/90, 140/80mmHg)
CREA 435 567 1078
BUN 13.5 14.5 19.2
CONSOLIDATION OF
Normal Values: TISSUES
HYPERTROPHY OF THE
CREA: 49-90 umol/L
BUN: 2.1-7.1 mmol/L REMAINING NEPHRONS
INCREASED INCREASED CARDIAC S/Sx:
HYDROSTATIC PRESSURE WORKLOAD  PRODUCTIVE COUGH (YELLOW GREEN
SPUTUM)
 USE OF ACCESSORY MUSCLES IN
BREATHING
FLUID LEAKAGE INTO CARDIOMEGALY  BODY WEAKNESS
THE INTERSTITIAL SPACE  FEVER & CHILLS
 PINK FROTHY SPUTUM
CHEST PA-
COMPARATIVE
S/Sx: S/Sx:
(09/28/19)
 CRACKLES  VENTRICULAR
THERE IS NO  NASAL FLARING GALLOP (S3) CHEST PA-COMPARATIVE
SIGNIFICANT INTERVAL  USE OF  EDEMA (09/28/19)
DECREASE IN ACCESSORY  CHEST PAIN
BILATERAL BASAL MUSCLES IN  COUGHING THE CARDIAC SILHOUETE IS
OPACITIES WHICH BREATHING  FATIGUE ENLARGED WITH
OBSCURES THE  O2 ATTACHED @
HEMIDIAPHRAGMS- A 3L/MIN. ACCENTUATED SUPRAHILAR
PLEURAL REACTION OR  PULMONARY VASCULATURE INDICATIVE
AN EFFUSION IS EDEMA OF CONGESTION.
ENTERTAINED
 SHORTNESS OF
BREATH

S/Sx: INABILITY TO LOSS OF SODIUM IN HYPONATREMIA

DILUTE POLYURIA
CONCENTRATE URINE THE URINE
URINE OUTPUT:
 DECREASED HYPERPHOSPHATEMIA DECREASED CALCIUM ABSORPTION HYPOCALCEMIA
PHOSPHATE EXCRETION

CHEMISTRY RESULT S/Sx:

09/28 10/10 10/ 28  TINGLING / TREMORS
 SPASM
Phosp 1.50 NONE 1.89  NAUSEA
horous  VOMITING
Normal Values:  DECREASED CARDIAC OUTPUT
Phosphorous: 0.87-1.45 mmol/L  TROSSEU’S SIGN
 CHVOSTEK SIGN
 BRUISING ON THE ARMS
 ECG ABNORMALITIES
 ABNORMAL HEART SOUNDS

CHEMISTRY RESULT
ECG RESULT (09/28/19) 09/28 10/10 10/ 28

 SINUS TACHYCARDIA Mg 0.63 NONE 89

FAILURE TO  POOR R WAVE Ionize 0.93 NONE 1.02

PRODUCE d Ca
ERYTHRO-
PROGRESSION Normal Values:
POIETIN  PVC Mg: 0.66-1.07 mmol/L
Ionized Calcium: 1.1-1.3 mmol/L
ANEMIA

DECREASED POTASSIUM
S/Sx: HYPERKALEMIA
 BODY EXCRETION
WEAKNESS
 FATIGUE
 BRUISES ON
ARMS DECREASED SODIUM WATER INCREASED INCREASED HYPERTORPHY
 SLOW REABSORPTION IN CARDIAC OF CARDIAC
RETENTION PRESSURE IN
CAPILLARY
REFILL (3 TUBULES BLOOD VESSELS WORKLOAD MUSCLES
SECONDS)
 PALE LIPS &
PALPEBRAL
CONJUNCTIVA S/Sx: EDEMA
 USE OF
ACCESSORY
MUSCLES IN
BREATHING
 SHORTNESS OF
BREATH

ECG RESULT (09/28/19) CHEST PA-COMPARATIVE S/Sx:

(09/28/19)  VENTRICULAR
 SINUS TACHYCARDIA GALLOP (S3)
THE CARDIAC SILHOUETE IS  EDEMA
HYPO- DECREASED FAILURE TO  POOR R WAVE ENLARGED WITH  CHEST PAIN
ABSORPTION CONVERT PROGRESSION ACCENTUATED SUPRAHILAR  COUGHING
CALCEMIA
INACTIVE VASCULATURE INDICATIVE  FATIGUE
 S/Sx:
 VENTRICULAR
GALLOP (S3)
 EDEMA
 CHEST PAIN
 COUGHING
 FATIGUE

S/Sx: CHEMISTRY RESULT

 TINGLING / ECG RESULT (09/28/19)
09/28 10/10 10/ 28
TREMORS
 SPASM Mg 0.63 NONE 89  SINUS TACHYCARDIA
 NAUSEA
 VOMITING Ionize 0.93 NONE 1.02  POOR R WAVE
 DECREASED d Ca
CARDIAC OUTPUT PROGRESSION DECREASED EXCRETION OF UREMIA IRRITATION OF NERVE ENDINGS
Normal Values: NITROGENOUS WASTES
 TROSSEU’S SIGN Mg: 0.66-1.07 mmol/L  PVC
 CHVOSTEK SIGN
Ionized Calcium: 1.1-1.3 mmol/L
 BRUISING ON THE
ARMS CHEMISTRY RESULT METABOLIC S/Sx:
 ECG
ABNORMALITIES 09/28 10/10 10/28 ACIDOSIS  PERICARDITIS
 ABNORMAL HEART CREA 435 567 1078  CHEST PAIN
SOUNDS  VOMITING
BUN 13.5 14.5 19.2
 PRURITUS
Normal Values:  NEUROLOGIC
CREA: 49-90 umol/L CHANGES
BUN: 2.1-7.1 mmol/L  TREMORS