Essay Available:
Pages:
6 pages/≈1650 words
Sources:
12 Sources
Level:
Harvard
Subject:
Health, Medicine, Nursing
Type:
Case Study
Language:
English (U.K.)
Document:
MS Word
Date:
Total cost:
$ 29.16
Topic:
Case studies (Case Study Sample)
Instructions:
i would like you to solve this 2 case studies
You should include a Bibliography (rather than a reference list) of all the sources of information you have consulted to help solve the cases, not just the ones that you may reference within your answers.
you can use as many sources as you wish but please not less than 12
please can you do it as soon as you can ,
thanks
Nawaf source..
Content:
CASE STUDY 1:
A 20 year old male, a known insulin-dependent diabetic, was brought to hospital in a coma. Analysis of a blood sample gave the following results:
Analyte
Patient
Reference(*)
glucose
41mM
3.0 - 5.5mM
acetoacetate
2.6mM
<0.20mM
-hydroxybutyrate
12.0mM
<0.25mM
HCO3-
7mM
23-33mM
urea
10.1mM
3.0 - 8.0mM
* The reference values refer to the concentrations in a “normal” patient.
Why is [glucose] high?
The patient described in this case study is a known case of Insulin-dependant diabetes mellitus (Type 1 Diabetes Mellitus). Type 1 DM is a metabolic disorder resulting from the autoimmune destruction of the pancreatic beta cells located in the Islets of Langerhans which results in a progressive disability to secrete insulin (Votey & Peters, 2007). Type 1 DM can present at any age the most common presentation being in childhood, as in this case, but one-fourth of cases are diagnosed in adults. (Levitsky & Misra, 2008).
The destruction of pancreatic islet cells in patients with Type 1 DM leads to an absolute or relative deficiency of insulin, which is a key enzyme involved in the metabolism of glucose, resulting in hyperglycemia and abnormal carbohydrate, fat and protein metabolism. The patient in this case is currently suffering from Diabetic Ketoacidosis (DKA). In this condition, the hyperglycemia is multifactorial, resulting not only from the underutilization of glucose, occurring due to insulin deficiency, but also from overproduction (Charfen & Fernandez-Frackelton, 2005, pp. 610-611). DKA is a state where insulin deficiency is compounded by an increase in the counter-regulatory stress hormones such as glucagon and cortisol. These hormones result in the overproduction of glucose via the processes of glycogenolysis (conversion of glycogen into glucose) and gluconeogenesis (de novo production of glucose in the liver) (Charfen & Fernandez-Frackelton, 2005, p. 611; Wallace & Matthews, 1997, p. 773). Thus, it is the combination of glucose underutilization and overproduction that leads to hyperglycemia in diabetic patients presenting with DKA.
What are acetoacetate and β-hydroxybutyrate, and how are they produced in the body?
Acetoacetate, β-hydroxybutyrate and Acetone are products of fatty acid metabolism which are termed as ‘Ketone Bodies’ or simply ketones (Wallace & Matthews, 1997, p. 773). These substances are weak organic acids and when they accumulate in the human body, they can lead to metabolic acidosis (Charfen & Fernandez-Frackelton, 2005, p. 611). In DKA, the insulin deficiency and increased levels of stress hormones result in an increase in the process of lipolysis, i.e. the production of acetyl CoA from fatty acids (Wallace & Matthews, 1997, p. 773). In addition to increased lipolysis, there is inhibition of lipogenesis which prevents the acetyl CoA from being utilized via the TCA cycle. Instead, acetyl CoA is oxidised into acetoacetate and β-hydroxybutyrate via the HMG-CoA pathway which occurs exclusively in the hepatic mitochondria, resulting in ketonemia (i.e. the presence of ketones in the blood) (Charfen & Fernandez-Frackelton, 2005, pp. 611-612; Newsholme, Leech, & Board, 2010, pp. 138-139).
Explain the concentrations of the acetoacetate and β-hydroxybutyrate.
In this patient, the levels of acetoacetate and β-hydroxybutyrate are very high as compared to the normal ranges. As discussed above, in patients with DKA, the deficiency of insulin along with the excess of counter-regulatory hormones, results in lipolysis. Moreover, there is inhibition of lipogenesis. Both these factors result in increased concentrations of acetoacetate and β-hydroxybutyrate via the mechanisms discussed above.
Why is the β-hydroxybutyrate greater than the acetoacetate?
As depicted in the lab findi...
A 20 year old male, a known insulin-dependent diabetic, was brought to hospital in a coma. Analysis of a blood sample gave the following results:
Analyte
Patient
Reference(*)
glucose
41mM
3.0 - 5.5mM
acetoacetate
2.6mM
<0.20mM
-hydroxybutyrate
12.0mM
<0.25mM
HCO3-
7mM
23-33mM
urea
10.1mM
3.0 - 8.0mM
* The reference values refer to the concentrations in a “normal” patient.
Why is [glucose] high?
The patient described in this case study is a known case of Insulin-dependant diabetes mellitus (Type 1 Diabetes Mellitus). Type 1 DM is a metabolic disorder resulting from the autoimmune destruction of the pancreatic beta cells located in the Islets of Langerhans which results in a progressive disability to secrete insulin (Votey & Peters, 2007). Type 1 DM can present at any age the most common presentation being in childhood, as in this case, but one-fourth of cases are diagnosed in adults. (Levitsky & Misra, 2008).
The destruction of pancreatic islet cells in patients with Type 1 DM leads to an absolute or relative deficiency of insulin, which is a key enzyme involved in the metabolism of glucose, resulting in hyperglycemia and abnormal carbohydrate, fat and protein metabolism. The patient in this case is currently suffering from Diabetic Ketoacidosis (DKA). In this condition, the hyperglycemia is multifactorial, resulting not only from the underutilization of glucose, occurring due to insulin deficiency, but also from overproduction (Charfen & Fernandez-Frackelton, 2005, pp. 610-611). DKA is a state where insulin deficiency is compounded by an increase in the counter-regulatory stress hormones such as glucagon and cortisol. These hormones result in the overproduction of glucose via the processes of glycogenolysis (conversion of glycogen into glucose) and gluconeogenesis (de novo production of glucose in the liver) (Charfen & Fernandez-Frackelton, 2005, p. 611; Wallace & Matthews, 1997, p. 773). Thus, it is the combination of glucose underutilization and overproduction that leads to hyperglycemia in diabetic patients presenting with DKA.
What are acetoacetate and β-hydroxybutyrate, and how are they produced in the body?
Acetoacetate, β-hydroxybutyrate and Acetone are products of fatty acid metabolism which are termed as ‘Ketone Bodies’ or simply ketones (Wallace & Matthews, 1997, p. 773). These substances are weak organic acids and when they accumulate in the human body, they can lead to metabolic acidosis (Charfen & Fernandez-Frackelton, 2005, p. 611). In DKA, the insulin deficiency and increased levels of stress hormones result in an increase in the process of lipolysis, i.e. the production of acetyl CoA from fatty acids (Wallace & Matthews, 1997, p. 773). In addition to increased lipolysis, there is inhibition of lipogenesis which prevents the acetyl CoA from being utilized via the TCA cycle. Instead, acetyl CoA is oxidised into acetoacetate and β-hydroxybutyrate via the HMG-CoA pathway which occurs exclusively in the hepatic mitochondria, resulting in ketonemia (i.e. the presence of ketones in the blood) (Charfen & Fernandez-Frackelton, 2005, pp. 611-612; Newsholme, Leech, & Board, 2010, pp. 138-139).
Explain the concentrations of the acetoacetate and β-hydroxybutyrate.
In this patient, the levels of acetoacetate and β-hydroxybutyrate are very high as compared to the normal ranges. As discussed above, in patients with DKA, the deficiency of insulin along with the excess of counter-regulatory hormones, results in lipolysis. Moreover, there is inhibition of lipogenesis. Both these factors result in increased concentrations of acetoacetate and β-hydroxybutyrate via the mechanisms discussed above.
Why is the β-hydroxybutyrate greater than the acetoacetate?
As depicted in the lab findi...
Get the Whole Paper!
Not exactly what you need?
Do you need a custom essay? Order right now:
YOU MAY ALSO LIKE
- Ethnography Essays
- Dance Essays
- Depression Essays
- Conflict Essays
- Scientific Essays
- Human rights Essays
- Career Essays
- A rose for emily Essays
- Personal experiences Essays
- Things fall apart Essays
- Abraham lincoln Essays
- Heart of darkness Essays
- Suicide Essays
- Fast food Essays
- Short story Essays
- French revolution Essays
You Might Also Like Other Topics Related to progressive era:
- The Populists, the Progressive Era, the New Deal, the Great Society, and the 1980s in Americ. . .Description: Undergraduate level Research Paper: The Populists, the Progressive Era, the New Deal, the Great Society, and the 1980s in America...5 pages/≈1375 words | 6 Sources | Chicago | History | Research Paper |
- Finance: WalmartDescription: Undergraduate level Essay: Finance: Walmart...1 page/≈275 words | 1 Source | APA | Business & Marketing | Essay |
- The Growth of Robinson CrusoeDescription: Undergraduate level Essay: The Growth of Robinson Crusoe...2 pages/≈550 words | 1 Source | Other | Literature & Language | Essay |