Question

A 9-year-old boy has a history of a recent viral infection. He now feels faint and is feverish, and he is generally not well. He has to urinate frequently and is very thirsty. His breath smells fruity. He is seen in an urgent care clinic, where blood is drawn and urine collected for routine urinalysis. The following urinalysis results were obtained:

Physical Appearance

Color: Pale

Transparency: Clear

Chemical Screening

pH: 5.0

Specific gravity (refractometer): 1.029

Specific gravity (reagent strip): 1.005

Protein (reagent strip): Negative

Blood: Negative

Nitrite: Negative

Leukocyte esterase: Negative

Glucose: >2000 mg/dL

Ketones: Large

Bilirubin: Negative

Urobilinogen: Negative

Microscopic Examination

Red blood cells: 0-2/hpf

White blood cells: 0-2/hpf

Critical Thinking Questions

1. Why are ketone bodies present in such a large quantity?

2. How does this patient’s condition differ from the conditions of other patients who might demonstrate the presence of ketone bodies?

Answer 1

1.These clinical evidence given a clear diagnosis for child having Diabetic ketoacidosis. DKA arises dur to lack of adequate insulin in the body. Main cause for these condition is cerebral edema.

2.child already have type 1 or 2 DM or cerebral edema. That's why urine shows presence of ketone bodies and acidic in nature.In these condition large number of protein excreted through urine. That's why urgency of urine occur. Kussmaul respiration , dehydration present. Treated with sodium bicarbonate to correct acidosis part. Insulin, fluid therapy are used as management measures.