Question

Critical Thinking Question (5 pts.) (You may use the back of the page to write your answer if needed). Today's question has 2 parts. Use what you have learned in the lecture on Endocrine system to answer both parts: 1 Kyle has been diagnosed with Diabetes Mellitus type I when he was 12 years old. Today, Kyle is a 23 year old drummer in a rock band. He partied hard last night, and today he missed the band rehearsal. So his bandmates came to his apartment to check up on him and found Kyle unresponsive in bed. There was a strong smell of acetone in the room. They called an ambulance and Kyle was transported to a hospital. Upon assessment, Kyle's glucose was found to be in the high 500's, he was dehydrated, and diagnosed with Diabetic Ketoacidosis. In addition, there was a nasty abscess found on his back from an old spider bite that happened a month ago. Kyle was given lots of IV fluids, which helped Explain what is going an with Kyle now? How did he end up with DKA? a. b. Why the old spider bite did not heal and turned into an infection? Why was he given IV fluids? And how did that help? C 2 3 years later, Kyle has his diabetes under control. He is traveling today from San Francisco to New York, but due to a bad weather, his flight was delayed. Now that the plane is finally in the air, Kyle started acting strange, nervous and anxious. The flight attendant noticed that Kyle was shaking and sweaty. She offered him some 7UP. When Kyle had the beverage, he felt better. a Explain, what happened in this case: why did Kyle act strange and was shaking and sweating b Why drinking the 7UP helped?

Answer 1

Answer of 1a:

Kyle is suffering from Diabetes Mellitus 1 that means his body do not synthesize insulin or synthesize inadequate/less potent / defected insuline. So he would be on insulin from the day he was diagnosed. Then the dose of insulin would regulated by the treating doctor. He would not be in regular meeting with his doctor. So insuline shot, had been taking by him would be inadequate. And Blood glucose level would be increasing gradually. That continuous raised level of glucose in blood decrease the immunity by decreasing the numbers and functioning of neutrophill. Raised blood glucose level also compromise the T lymphocyte as well as reduce the releasing of various interleukins. All these factors are responsible for decrease capacity of fighting against infections. A spider bite on the back of Kyle grown with infection. This infection on back could also be not noticed by kyle. Because raised blood glucose level also causes neuropathy. So the nerves transmission would got weak and area supplied would became insensitive. Thats why one month progressive infection could not be detected.

Now question arise how he became unconscious with acetone smell. In last night party , he would consumed alcohol. As well as Insuline would not be taken. So the old infectious wound, raised blood glucose and alcohol could triggered the ketoacidosis. At night in kyle's body glucose could not be enter into cells due to lack of insulin. Insulin also prevent mobilisation of free fatty acid from adipocytes . So due to lack of insulin the free fatty acids mobilized from adipocytes and entered in hepatocytes. Where in the mitochondria of hepatocytes these converted in to keto acids viz. Acetoacetic acide, beta hydroxy butyric acid. These keto acids are utilise for energy in non-comolicated Diabetes. But in case of Kyle , excess synthesis of keto acids also convert into acetone and also excrete in urine. This acetone is volatile and excreted by respiratory system . It is reponsible for acetone breath.

When the glucose wws not entering and utilizing in the cells, resulted into hyperglycemia. This raised level in blood raise the osmalarity. So the more water is needed to balance this osmalarity. But kyle would not drink enough water in night. Excretion of keto acids also cause natriuresis( sodium in urine) . Natriuresis also result in water loss. Ultimately result in dehydration. Raised osmalarity with volume depletion caused the deprivation of water in brain so unconsciouness occured.

Answwr of 1b : it is explained in 1a

Hyperglycemia decreases the immunity by decreasing numbers and functions of neutrophills as well as T lymphocytes. It decreases the interleukin 1 and 6. Decreases chemotaxis of monocyte and neutrophills. All required to combat infection. Hyperglycemia also causes angiopathy so peripheral blood supply slow down it also raise the chances of peripheral infection. Neuropathy caused by hyperglycemia result in anaesthesia of the skin so wound infection is less painfull and could not be noticed. Raise sugar level also utilize by pathogens so they grow up strongly. these all factors contributed in old spider bite could convert into infection.

Answer of 1c :

500mg/dl is far more than normal 125mg/dl . So the osmalarity was increased in Kyle's blood and ECF. So the water is needed to combat osmalarity. Excretion of keto acids also result in sodium loss. So sodium chloride saline would have been useful. Fluid decreased the osmalarity so body cells could get water and hydrated again. More fluid also helps in excretion of excessive glucose and ketones. So the condition would improve. Dehydrated brain cells would be hydrated.

Answer of 2 a:

In this case there was insuline dose taken but less food was taken. So the blood glucose level would went down earlier before next meal. Or enough food was taken but skspped the next meal . In both case resulted in hypoglycemia. Hypoglycemia characterised by lack of glucose in brain so the nervous, strange feeling occured. Then, brain in hypoglycemia triggered the stress response. Which resulted in sympathetic stimulation and glucocorticoid secretion. Sympathetic stimulation causes anxiety, shaking, increased heart rate and sweating etc.

Answer of 2b.

Glucose in 7up restored the glucose level so the response is reversed. Sympathetic stimulation is withdrawn.