Biology - Anatomy homework help

Anatomy and Physiology 2 Lab Name ________________________________

Case Study Patient History and Chief Complaint.

Chief Complaint: 7-year-old girl experiencing unexpected weight loss and says she is thirsty all

of the time and needs to urinate frequently.

History: The parents of Rylee Langdon, a 7-year-old female, made the decision to contact their

pediatrician because over the past three days, Rylee has been feeling nauseated, vomited on

three occasions, and was complaining of having a headache. Rylee otherwise had been in

previously good health, she also noticed that, in the past month, she has been increasingly

thirsty. She gets up several times a night to urinate and finds herself gulping down glassfuls of

water. At the dinner table, she seems to be eating twice as much as she used to, yet she has

lost 6 pounds in the past month.

While at the office visit, it is noted that Rylee is breathing rapidly and taking deep breaths and

has a fruity odor to her breath. On physical examination, blood and urine samples are taken.

The following lab results are noted:

Test Test result Normal result

Blood glucose level 454 mg/dL 50-170 mg/dL

Blood pH 7.15 7.35-7.45

Urine Glucose Positive Negative

Urine Ketone Positive Negative

Urine color Clear Light yellow-amber

Specific gravity 1.008 1.010-1.026

Urine pH 6 6-8

Following her visit to the pediatrician, Rylee undergoes a diabetic care training program,

learning how to self-inject insulin subcutaneously and check her blood-glucose level at home

using chemstrips. In addition, she learns the importance of carrying candy and glucagon with

her at all times as well as eating the right amounts of food at the right times each day. Rylee is

started on the following schedule of 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 units

Three days later, she returns to the doctor's office for a review of her blood-glucose readings

and a measurement of her fasting blood-glucose level, which is found to be 95 mg/dl. Most of

her glucose readings during the day have been in the low- to mid-100 range. Her glucose levels

before supper, however, are in the upper 200s.

Rylee returns to her pediatrician three months later for a re-check and is found to have a

glycosylated hemoglobin level (Hb A1C) of 9.5%. The years progress, and Rylee has

considerable difficulty controlling her diabetes. She has been told that she has "brittle" diabetes,

a form of the disease marked by wide swings in blood-glucose levels despite the best efforts at

control. Rylee is advised by her physician that she is at risk for developing certain complications

of diabetes and it is advised to never walk barefoot. In her mid-forties, Rylee began to show

early signs of diabetic nephropathy (kidney disease), consisting of persistent proteinuria,

hypertension, and gradually decreasing renal function as measured by chemical tests. She

nonetheless felt fairly healthy over the next 10 years. At age 55, however, she has noticed

becoming increasingly fatigued upon mild physical exertion and requiring more sleep than

previously. In addition, she has generally felt nauseated most of the time, and in the past two

weeks, has vomited on several occasions. She has increased swelling in her ankles and is short

of breath. She has also become less responsive over the past day or so. Laboratory tests reveal

that her kidney disease is now progressing at a much faster rate:

BUN (blood urea nitrogen) = 56 mg / dl (normal = 10 - 20 mg / dl)

Urinary output = 25 cc / hour (normal = 50-60 cc / hour)

Rylee is advised by her physician that her kidneys are failing. She is informed about treatment

options: hemodialysis vs. continuous ambulatory peritoneal dialysis (CAPD) vs. kidney

transplant. In consultation with her physician, Rylee chooses to undergo hemodialysis. A

checkup two weeks after beginning dialysis reveals the BUN has decreased to 35 mg / dl.

Although hemodialysis is fairly effective, it is not fool proof. For example, patients with chronic

renal failure, despite a regular schedule of hemodialysis, will experience disruptions in calcium

and phosphate balance.