17 y/o male with DM is evaluated in emergency room because of lethargy, disorientation, and rapid breathing with long deep breaths.
The initial biochemical results of his venous blood are as shown.
Test results – pH (7.30), Normal (7.35-7.45)
- Hco3 (15 mmol/L), Normal (22-28)
- pCO2 (30 mmHg), Normal (35-45)
- glucose (15 mmol/L), Normal (4.2-6.2)
- urine ketone (+ve)
Explain the act of long deep breaths in this patient in relation to his blood investigation results.
Anyone can explain??
Sunday, March 22, 2009
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4 comments:
ok..fisrtly...soklan "initial biochem result of his VENOUS blood" spttnye, kite amek ARTERIAL blood Gas, ABG tok assess acid-base imbalance..
Secondly, establish diagnosis , ya Diabetic Ketoacidosis..
Thirdly, assess acid-base status: ph is <7.35 so acidosis, n [HCO3] <24, so diagnosis for acid base is METABOLIC ACIDOSIS.
ok, now, xplain action of long deep breaths, meaning that is it compensated or not, n mechanism of compensation.... so, pCO2 < 40, therefore, it is compensated metabolic acidosis
Provisional diagnosis is Compensated metabolic acidosis secondary to diabetic ketoacidosis
Mechanism of compensation:
need to increase ventilation, i.e. HYPERventilation as to remove xs CO2...
correct me if i'm wrong
~~~just add jer tok case kat atas~~~
ACID BASE STATUS:METABOLIC ACIDOSIS
Pathophysiology(cause)
*energy utilization:low blood glucose & energy must b derived from fat
*adipose tissue--->fat mobilization--->FA transported to liver via albumin--->beta oxidation of FA--->increased acethyl CoA--->ketogenesis(synthesis of ketone bodies in liver)--->ketone bodies enter blood--->increased blood ketones(acidic)--->low blood pH(acidosis)
COMPENSATION:RESPIRATORY ALKALOSIS
*acidosis--->will stimulate respiratory centre--->hyperventilate--->expel Co2 via lungs--->increase blood pH...
thanks!
The type of Breathing in DKA is Kussmaul's respiration. This breathing is characterized by deep inspirations and acetone breath..
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