Question

Chief Complaint:B-year-old girl with excessive thirst, frequent urination, and weight loss. The following measurements were recorded in the MD's office: Current height: 53 inches, weight 30.1 kg. BMI: 18 History: Cindy Mallon, an 8-year-old girl in previously good health, has noticed that, in the past month, she is increasingly thirsty. She gets up several times a night to urinate, and finds herself gulping down glassfulls of water. At the dinner table, she seems to be eating twice as much as she used to, yet she has lost 5 pounds in the past month. In the past three days, she has become nauseated, vomiting on three occasions, prompting a visit to her pediatrician. Questions At the doctor's office, blood and urine samples are taken. The following lab results are noted blood glucose level 545 mg/d blood pH level 7.23 normal 50-170 mg/d normal-7.35-7.45 urine tested positive for glucose and for acetone/ acetoacetate (ie ketone bodies) Inormally urine is free of glucose and ketone bodies) 1. Why is her blood-glucose level elevated? 2. Why is her blood pH level decreased? 3. At the office, Cindy is breathing rapidly and taking deep breaths. What physiological purpose does this serve? 4. What sugsestions could you offer Cindy's caregivers or parents to provide them with support as they care for their daughter at home? Discuss the potential complications for Cindy i she or her caregivers are not compliant with her medical regimen while at home 5. Explore the literature and research and discuss the immediate and future nutritional needs for Cindy. What education regarding Cindy's nutritional needs can be provided to the parents or cacealvcrs as thex orcoare to takc her.home

Answer 1

1. ANS: Cindy has diabetes (insulin dependent diabetes mellitus). Cindy pancreas did not make sufficient amount of insulin hormone. The insulin hormone was responsible to regulate the blood-glucose level of body by two mechanisms.

a) It tends to lower the blood sugar level, through stimulating the uptake of glucose from blood, into skeletal muscle, adipose tissue, and some other tissues.

b) Enhancement of the effects of some regulatory hormones (which raise blood glucose levels) i.e. glucagon, epinephrine, and cortisol during insulin deficiency conditions. Thus deficiency of insulin resulting to increase in the blood glucose level.

2. ANS:   Her blood pH level decreased to 7.23 instead of normal (7.4)

Cindy blood pH level was decreased due to the Ketoacidosis (Metobolic Acidosis). While insulin's action was decreased, then glucagon's effect was enhanced. Insulin promotes absorption of blood lipids into adipose tissue and the glucagon stimulates lipid breakdown from adipose tissue. The liver metabolizes lipids and produces ketone bodies. Increased glucagon activity and decreased insulin activity cause blood lipid levels to rise. Beta-hydroxybutyric acid and acetone acetoacetic acid are the major ketone bodies produced. As levels of the beta-hydroxybutyric acid and acetone acetoacetic acid rise in the bloodstream, the pH of the blood falls.

3. ANS:   The rapid breathing pattern (with deep breaths) is a known as hyperventilation. Hyperventilation serves to reduce the level of carbon dioxide (CO2) in the bloodstream at faster rate. In bloodstream, CO2, carbonic acid (H2CO3), and bicarbonate ions (HCO-3) in the bloodstream can be inter converted by the following catalytic reaction of enzyme carbonic anhydrase:

CO₂ + H₂O   H₂CO₃   H⁺ + HCO^-₃

Lowering the CO2 concentration in the blood would causing more HCO3- and H+ to bind together to form H2CO3, which will be converted back to CO2 and H2O (to maintain the equilibrium). This process would effectively removes more H+ from the bloodstream and resulting to increase the pH of the blood, which will eventually compensating for metabolic acidosis (as in case of Cindy).

5. ANS:   During the process of diabetes management and treatment the dietary modifications can plays a crucial role. Some foods can reduce and minimize the symptoms and effects of diabetes and some foods may be beneficial other foods could react adversely.

Reduce Cindy fat intake and cut back on the salt

In Cindy diet Include whole grain foods, vegetables and fresh fruits.

Be cautious about Cindy carbohydrate intake

Limit Cindy intake of sugar rich foods

Be cautious about Cindy carbohydrate intake

Increase the frequency of Cindy meals through smaller serving sizes

Please consider this note: Answering to many questions (more than four) is against to HOMEWORKLIB RULESS, if you are satisfied with my answer please rate it.