Question

Billy is an 11-year-old boy who was admitted to hospital with dehydration. His parents said that over the last few months, he had seemed tired and lacking in energy, and that despite eating well and drinking large quantities of fluids he had lost about 7 kg (15 lbs) in weight. He also seemed to be going to the toilet frequently, not only during the day but also during the night. On examination, there was evidence of dehydration (sunken eyes, loss of tissue turgor); his pulse rate was 115 BPM, blood pressure was 95/55 mmHg, respiratory rate was 20 breaths per minute, and his breath smelled of acetone.
1. Comment on the history and findings following the physical examination of Billy.

2. Comment on and interpret the test strip results. Are they consistent with your provisional diagnosis based on the history and physical examination findings?

Answer 1

Answer:

Billy  showed signs of type 1 diabetes.This is because,

1.His dehydration was from polyuria- excessive urination.

2. because of failure of his  pancreas to secrete insulin, for cellular utilization of glucose by beta cells-  he retains glucose in his  blood, and  lost  a lot of  glucose in his urine, thus water follow by osmosis, leading to polyuria causing dehydration.

His urge to replace lost glucose and fluids leads to great thirst polydipsia, another symptoms of type1. However, his  drop  in weight is  because, the solute concentration  of blood glucose is high due to lack  of  insulin.Therefore large amount is lost in the urine, with large volume of fluids leading to drop in  weight, and energy because cells lack glucose for biochemical reaction of energy production.

The dehydration leads to sunken eyes, loss of tissue turgor, and low fluid levels results in drop in blood pressure,-Hyportension.

Due to lack of glucose in the blood gluconeogensis sets in. Fats is converted to glucose by the liver  to supplement the lost glucose. The major by product of this reaction is a ketone-acetone. This explains the reason for the smell of acetone in his  breath.

2, The Test strip indicated large quantity of ketones. above ,3.0mmol/L .This is a confirmation of the Type 1 diabetes mellitus in Billy.As more fats molecules are broken down to glucose.

Explanation: