milu
Forum Junior
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Posts: 35
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A 12 year old boy was examined in the emergency room. his mother said he was having frequent urination lasting seeral days. he was also compalining of feeling weak and tired.
PHYSICAL EXAMINATION
color - pale yellow
Clarity - clear
CHEMICAL EXAMINATION
pH - 6.0
Specific gravity - 1.025
Protein - Trace
Glucose - 1000mg/dl
Keton - 5mg/dl
Nitrite - neg
Blood - neg
Bilirubin - neg
Urobilinogen - neg
Leukocyte - neg
MICROSCOPIC
Rbc - 0 to 2 per field
Wbc - 0 to 2
Bacteria - few
Epithelial Cells - few
OTHER TESTS
SSA( sulfosalicylic acid test) - trace
QUESTIONS.
1) Which results are outside the normal range?
2) based on these result, what might be the diagnosis?
3) what is the relationship between the appearance of ketones in urine and carbohydrate metabolism?
Please explain if anyone has an answer... :|
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truth is great yet truthful living is the greatest....
Mili
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| Idiopathic
Forum Guru
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Posts: 641
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Glucose is extremely high, and ketones are abnormal, since they should be 0. However, they are very low. This would more than likely indicate diabetes (type I).
The presence of ketones in the urine indicates a shift from carbohydrate catabolism to fatty acid catabolism, since ketones are the end product of the FA pathway.
Glucose should never be present in this amount. The normal renal threshold for glucoe reabsorption is about 200mg/dL, and when stressed, it can reabsorb 300mG/dL. In cases of severe hyperglycemia (i.e. type I diabetes), the renal reabsorption threshold is exceeded, and glucose spills into the urine. This Px probably has a very high blood sugar (600-800 or so), and is probably ill, with flu-like symptoms.
Other things to consider in diabetes: polyuria, polydipsia, polyphagia. Parents will say "he eats and eats and seems to be losing weight". Generally these Px present to the doctor in DKA, so proper management is imperative.
Nugget: Na+ is normally the major osmotic attractant of serum, but in extreme hyperglycmeic cases, glucose takes over, and the Px will look like they are hyponatremic. A calculation can be done to correct for this, and serum Na+ is usually elevated, due to the dehydrated state of the body.
Diabetes insipidus also presents with polyuria and glucosuria, but NO KETONES.
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| mash
Forum Fanatic
Topics: 147
Posts: 1,326
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to add a few more pts,
pathogenesis of hyperglycemia
-In IDDM, due to lack of insulin there is decreased uptake of glucose by sk ms & adipose ts. This is bcoz uptake in these ts is insulin dependant.
so, fat met takes over which causes increase in ketones
-inc in glycogenolysis due to glucagon n counter reg hormones
-inc in gluconeogenesis due to glucagon
pathogenesis of ketone bodies
-inc lipolysis( glucagon stimulates hormone sensitive lipase)
-acetoacetate converts to acetone givin fruity odour to breath
severe vol depletion --is due to osmotic diuresis n loss of salt in hypotonic prportions
dilutional hypernatremia
hyperlipidemia
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| milu
Forum Junior
Topics: 18
Posts: 35
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THANK YOU!!!!!!!!
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truth is great yet truthful living is the greatest....
Mili
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