CASE STUDY: CAROL
BY: MANPREET KAUR, SARAH RILEY, BEN AVILA
INITIAL PRESENTATION
Sex: Female
Age: 8 years old
Presenting Problem: polydipsia, polyphagia, osmotic diuresis, sudden
weight loss, nausea and vomiting.
PRESENTING PROBLEMS
Polydipsia: excessive thirst. This is happening to Carol due to excessive
urination which is causing her to dehydrate.
Polyphagia: constant hunger. In Carol’s case of insulin-dependent diabetes
mellitus the more active glucagon activity raises her blood glucose and blood
lipid levels. There are not enough levels of insulin to allow skeletal muscles and
other tissues to take up the nutrients from the blood and use them as energy. As a
result, these tissues that rely on the insulin to stimulate the nutrient uptake are
starving and not getting enough glucose.
CONTINUED….
Osmotic Diuresis: Frequent urination. This is happening to Carol since she
has high blood glucose levels and the glucose is being filtered out of her
bloodstream and into her renal tubules. The rate of glucose being filtered is
higher than usual and the glucose cannot be reabsorbed into the blood steam
as quickly. Due to the glucose overload in the renal tubules, draw water by
osmosis causing her to urinate more frequently.
HISTORY
Previously good health
Changes in the past month:
- increasingly thirsty
- gets up several times a night to urinate
- gulping down glasses or water
- eats twice as much than used to
- lost 5 pounds of weight
PHYSICAL EXAMINATION BEFORE
TREATMENT
Blood glucose level: 545 mg/dl (normal: 50-170mg/dl)
*Carol has insulin-dependent diabetes, since her pancreas is not making
insulin. Insulin helps with the lowering of blood glucose levels.
Blood pH level: 7.23 (normal: 7.35-7.45)
*There is no insulin being produced (helps with getting glucose to the
muscles and tissues), so glucagon is used more. The muscles and tissues can’t
use glucose for energy, so the glucagon helps these areas get lipids.
CONTINUED…..
Breathing rapidly during physical examination
*She is hyperventilating. By doing so her body decreases carbon dioxide that in
turn raises the pH.
Urine: +ve for glucose & acetone/acetoacetate (normal: -ve for glucose &
ketone bodies)
*The liver then metabolizes the lipids and produces ketone bodies. This
increase in ketone bodies lowers the pH and this is known as diabetic ketoacidosis
DIAGNOSIS
Primary Diagnosis: Increased glucose levels
Differential Diagnosis: Hyperglycemia, Diabetes, Diabetic KetoAcidosis
TREATMENT: INSULIN DOSING
Morning dose: 8 units of NPH insulin and 4 units of regular insulin
Supper dose: 4 units of regular insulin
Bedtime dose: 5 units of NPH insulin
Total dose per day:21
DOCTOR’S APPOINTMENT 3 DAYS LATER
Fasting blood-glucose level: 95mg/dl
Blood- Glucose level during day: low to mid 100mg/dl
Glucose levels before supper: upper 200mg/dl
DOCTOR’S APPOINTMENT 3 MONTHS LATER
Glycosylated Hemoglobin Level (Hb A1C): 9.5 % (normal range:4%-
5.6%)
Glycosylated Hemoglobin: Hemoglobin to which glucose is bound.
Carol’s HbA1C levels predict the risk of microvascular complications of
diabetes.
LONG TERM COMPLICATIONS
Ketoacidosis (diabetic coma)
Cardiovascular diseases
Nerve damage
Damage to vision
Kidney damage/failure
Bone & Joint problems
Skin Problems
Teeth and gum infection
QUIZ
What is excessive thirst called?
What is Carol diagnosed with?
Why does she breathe rapidly?
What are two possible long-term complications that could arise?
What is frequent urination called?