A 16-year-old female consulted with her family practitioner because of tiredness and weight loss.

In: Nursing

A 16-year-old female consulted with her family practitioner because of tiredness and weight loss. On questioning,…

 

 

A 16-year-old female consulted with her family practitioner because of tiredness and weight loss. On questioning, she admitted to feeling thirsty and had noticed that she had been passing more urine than normal. The doctor tested her urine and found glycosuria. He arranged for her to be seen at the hospital’s diabetic clinic the next day. By then, however, she felt too ill to get out of bed, developed vomiting, and became very drowsy. Her father brought her to the emergency room when he was not able to wake her. On examination, she was found to have a blood pressure of 95/60 mmHg with a pulse rate of 112/min and cold extremities. She had deep, sighing respiration (Kussmaul’s respiration) and her breath had a “fruity odor”. The following laboratory results were determined:

•Glu 450 mg/dL

•Na 130 mmol/L

•K 5.8 mmol/L

•Cl 98 mmol/L

•TCO2 5 mmol/L

•BUN 60 mg/dL

•Crea 1.5 mg/dL

Ketones Positive

•1) What diagnosis fits these biochemical features? Account for all laboratory values.
•2) Calculate the anion gap and serum osmolality.

•3) Which of the results indicate some renal impairment?
•4) Why is the BUN disproportionately increased compared to the creatinine? Is this the result of something other than renal impairment?

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