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Given Her Elevated Blood Glucose Levels And Your Understanding Of Osmosis Explain Her Polyuria

Understanding The Presentation Of Diabetic Ketoacidosis

Understanding The Presentation Of Diabetic Ketoacidosis

Hypoglycemia, diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNS) must be considered while forming a differential diagnosis when assessing and managing a patient with an altered mental status. This is especially true if the patient has a history of diabetes mellitus (DM). However, be aware that the onset of DKA or HHNS may be the first sign of DM in a patient with no known history. Thus, it is imperative to obtain a blood glucose reading on any patient with an altered mental status, especially if the patient appears to be dehydrated, regardless of a positive or negative history of DM. In addition to the blood glucose reading, the history — particularly onset — and physical assessment findings will contribute to the formulation of a differential diagnosis and the appropriate emergency management of the patient. Pathophysiology of DKA The patient experiencing DKA presents significantly different from one who is hypoglycemic. This is due to the variation in the pathology of the condition. Like hypoglycemia, by understanding the basic pathophysiology of DKA, there is no need to memorize signs and symptoms in order to recognize and differentiate between hypoglycemia and DKA. Unlike hypoglycemia, where the insulin level is in excess and the blood glucose level is extremely low, DKA is associated with a relative or absolute insulin deficiency and a severely elevated blood glucose level, typically greater than 300 mg/dL. Due to the lack of insulin, tissue such as muscle, fat and the liver are unable to take up glucose. Even though the blood has an extremely elevated amount of circulating glucose, the cells are basically starving. Because the blood brain barrier does not require insulin for glucose to diffuse across, the brain cells are rece Continue reading >>

Glucose Tolerance Test

Glucose Tolerance Test

Carbohydrate forms the principle source of energy. Usually polysaccharide (starch and glycogen) which are glucose units joined by a-glucosidic links and disaccharides (sucrose and lactose) the main dietary carbohydrate. Carbohydrate absorption must be presented to the intestinal epithelium in monosaccharide from mainly glucose and therefore digestion must precede absorption. Glucose gained a significant importance because brain cells are very dependent on it as it is sole source of energy supply. Red blood cells also depend on glucose to carry out their functions. Therefore the blood glucose concentration must be maintained within relative narrow range. After a carbohydrate-containing meal, glucose is transported in the portal blood to the liver, which takes up 60% of the glucose load. Consequently, a rise in the blood glucose concentration causes the release of insulin which will increase the entry of excess glucose into the liver where it is stored in form of glycogen. The normal plasma glucose concentration remains between 4.5 and 11 mmol/L, despite the intermittent load entering the body from the gastrointestinal tract. The maintenance of plasma glucose concentration below 11 mmol/L minimizes loss from the body as well as providing the optimal supply to the brain. Mayne, (1994). All the filtered glucose through glomeruli is reabsorbed in the proximal tubules. Therefore no glucose should be detected in urine; significant glycosuria occurs if the plasma glucose concentration exceeds 11 mmol/L. The two most important hormones in glucose homoeostasis are insulin and glucagon. Insulin is a 53 amino acid polypeptide, secreted by the ?-cells in the islet langerhans of the pancreas in response to a rise in the blood glucose concentration. Insulin stimulates glycogen synthe Continue reading >>

Diabetic Ketoacidosis: A Serious Complication

Diabetic Ketoacidosis: A Serious Complication

A balanced body chemistry is crucial for a healthy human body. A sudden drop in pH can cause significant damage to organ systems and even death. This lesson takes a closer look at a condition in which the pH of the body is severely compromised called diabetic ketoacidosis. Definition Diabetic ketoacidosis, sometimes abbreviated as DKA, is a condition in which a high amount of acid in the body is caused by a high concentration of ketone bodies. That definition might sound complicated, but it's really not. Acidosis itself is the state of too many hydrogen ions, and therefore too much acid, in the blood. A pH in the blood leaving the heart of 7.35 or less indicates acidosis. Ketones are the biochemicals produced when fat is broken down and used for energy. While a healthy body makes a very low level of ketones and is able to use them for energy, when ketone levels become too high, they make the body's fluids very acidic. Let's talk about the three Ws of ketoacidosis: who, when, and why. Type one diabetics are the group at the greatest risk for ketoacidosis, although the condition can occur in other groups of people, such as alcoholics. Ketoacidosis usually occurs in type one diabetics either before diagnosis or when they are subjected to a metabolic stress, such as a severe infection. Although it is possible for type two diabetics to develop ketoacidosis, it doesn't happen as frequently. To understand why diabetic ketoacidosis occurs, let's quickly review what causes diabetes. Diabetics suffer from a lack of insulin, the protein hormone responsible for enabling glucose to get into cells. This inability to get glucose into cells means that the body is forced to turn elsewhere to get energy, and that source is fat. As anyone who exercises or eats a low-calorie diet knows, fa Continue reading >>

Why Do You Get Polyuria In Diabetes?

Why Do You Get Polyuria In Diabetes?

Polyuria (excessive volume of urine production) is common in uncontrolled diabetes. Under normal conditions the kidney can't help filtering some of the glucose in our blood stream. To urinate that out would be an unforgivable waste, and thankfully the kidney usually reabsorbs all the filtered glucose back into the bloodstream. Usually, that is. If the glucose level in the blood is too high, its capacity for reabsorption of gluocse is exceeded, and some of the glucose is lost in the urine. (Actually, this may be a good thing, since it helps to lower the blood glucose level if the latter is pathologically high.) The rough threshold for this in a (non-pregnant) person is about 10 mmol of glucose per litre. More than this, and some will end up in your urine. But why does more glucose in your urine lead to more urine being produced? The answer is that glucose is a powerful osmolyte. Like a handful of other substances (sodium, urea, mannitol, etc.) it has the ability to induce water to follow it, by osmosis, wherever it goes. And since there is more glucose than normal in the urine, there will also therefore be more water than usual in the urine - i.e. polyuria. [In fact, most of the acute complications of diabetes (e.g. diabetic ketoacidosis, or hyperosmolar coma) are largely due to the hyperosmolarity of the blood, secondary to high blood glucose levels. This induces water to leave cells, including those in the brain, which is the usual cause of death in these patients.] Largely, this whole debacle accounts for the three classic symptoms of uncontrolled diabetes: polyuria polydypsia (excessive ingestion of water, to make up for the extra water lost in the urine), and polyphagia (excessive eating, to make up for the calories you keep urinating away). Continue reading >>

Physiology Chapter 24

Physiology Chapter 24

- DM caused by damage to beta cells of pancreas - Type of DM is most common form of diabetes mellitus - can occur secondary to obesity, while obesity can also occur secondary to it - type of DM in which the age of onset has traditionally been thought to be in people over 40 years of age, but occurrence in children is found to be increasing, indicating a reduction in average age of onset - caused by DECREASED RESPONSE in tissues to insulin - DM is caused by damage to the alpha cells of the pancreas the subclass of type 1 DM that is an autoimmune disorder that attacks beta cells of the pancreas - subclass of type 1 DM that attacks antigens of proinsulin, glutamic acid decarboxylase, tyrosine phosphorylase-like protein, zinc transporter 8, and other proteins in the islets of Langerhans The subclass of type 1 DM that is also called idiopathic type 1 DM, it is the form that involves destruction of pancreatic beta cells Stimulates lipolysis and gluconeogenesis, it also increases blood fatty acid levels and ketone production a chemical messenger that induces the sensation of feeling full (satiety) acts on thirst centers in the anterior hypothalamus to trigger polydipsia A non-enzymatic glycosylation protein marker used for measuring the one-to-three-month average of blood glucose levels Symptoms include dehydration, fruity odor to breath, polyuria, and electrolyte imbalance Symptoms include blurred vision, hunger, tingling sensation, anxiety, and confusion first enzyme of glycolysis that has a great affinity for glucose Advanced-Glycosylation End-Products (AGEs) proteins that have been glycosylated through a non-enzymatic process known as glycosylation a disease of the cardiac muscle that weakens the heart, it is characterized by a reduction in the contractility of the cardia Continue reading >>

Thirst - Wikipedia

Thirst - Wikipedia

For other uses, see Thirst (disambiguation) . "Thirsty" redirects here. For other uses, see Thirsty (disambiguation) . William-Adolphe Bouguereau 's Thirst (1886) Thirst is the craving for fluids, resulting in the basic instinct of animals to drink . It is an essential mechanism involved in fluid balance . It arises from a lack of fluids or an increase in the concentration of certain osmolites , such as salt . If the water volume of the body falls below a certain threshold or the osmolite concentration becomes too high, the brain signals thirst. Continuous dehydration can cause many problems, but is most often associated with renal problems and neurological problems such as seizures. Excessive thirst, known as polydipsia , along with excessive urination, known as polyuria , may be an indication of diabetes mellitus or diabetes insipidus . There are receptors and other systems in the body that detect a decreased volume or an increased osmolite concentration. They signal to the central nervous system , where central processing succeeds. Some sources, [1] therefore, distinguish "extracellular thirst" from "intracellular thirst", where extracellular thirst is thirst generated by decreased volume and intracellular thirst is thirst generated by increased osmolite concentration. Nevertheless, the craving itself is something generated from central processing in the brain, no matter how it is detected. It is vital for organisms to be able to maintain their fluid levels in very narrow ranges. The goal is to keep the interstitial fluid, the fluid outside the cell, at the same concentration as the intracellular fluid, fluid inside the cell. This condition is called isotonic and occurs when the same level of solutes are present on either side of the cell membrane so that the net wa Continue reading >>

Ugg Pas Cher Ugg Keehwplu

Ugg Pas Cher Ugg Keehwplu

Homeostatic Imbalance - Diabetes mellitus - A Trip of Complications Homeostatic Imbalance - Diabetes Mellitus Diabetes mellitus results from either hyposecretion or hypoactivity of insulin. After a meal, when insulin is either absent or deficient, blood glucose levels remain high because glucose is unable to enter most tissue cells. Ordinarily, when blood glucose levels rise, hyperglycemic hormones are not released, but when hyperglycemia becomes excessive, you start to feel nauseated. The nausea causes your body to enter the "flight-fright-frolic" response. This is a series of changes brought about by the Autonomic Nervous System and prolonged by certain members of your Endocrine System. The results are inappropriate because they normally occur in the hypoglycemic (fasting state) to make glucose available. The nausea triggers glycogenolysis (breakdown of glycogen), lipolysis (breakdown of fat) and gluconeogenesis. These cause the already high glucose levels to soar even higher and excess glucose begins to leave the body in the urine (glycosuria). When simple sugars, such as glucose, cannot be used as cellular fuel, more fats are mobilized and broken down for fuel. The fats produce a high fatty acid level in the blood, a condition called lipidemia or lipemia. The presence of acids in the blood increases a persons free H+ ion count which results in a lower than normal pH.This is referred to asacidosis. When a H+ ion is free, by itself, it contributes to acidity. The purpose of buffering is to combine the free H+ and take it out of body fluids. When that happens the pH of the blood increases (Becomes Basic). In severe cases of diabetes mellitus, blood levels of fatty acids and their metabolites (acetoacetic acid, acetone and others) rise dramatically. The metabolites, co Continue reading >>

Why Does Diabetes Cause Excessive Urination And Thirst? A Lesson On Osmosis

Why Does Diabetes Cause Excessive Urination And Thirst? A Lesson On Osmosis

A TABA Seminar on Diabetes I have the pleasure of being an executive member of the Toronto Applied Biostatistics Association (TABA), a volunteer-run professional organization here in Toronto that organizes seminars on biostatistics. During this past Tuesday, Dr. Loren Grossman from the LMC Diabetes and Endocrinology Centre generously donated his time to deliver an introductory seminar on diabetes for biostatisticians. The Institute for Clinical and Evaluative Sciences (ICES) at Sunnybrook Hospital kindly hosted us and provided the venue for the seminar. As a chemist and a former pre-medical student who studied physiology, I really enjoyed this intellectual treat, especially since Loren was clear, informative, and very knowledgeable about the subject. Diabetes Diabetes is a group of metabolic diseases that are characterized by a high concentration of glucose in the bloodstream. Glucose is a common monomer of carbohydrates that exists in many foods, including bread, pasta, rice, fruits, vegetables, and refined sugar. It provides the fuel for the cells of our bodies to function. Chemical Structures of Open-Chain and Cyclic Glucose For a variety of reasons that distinguish the different types of diabetes, diabetics cannot absorb glucose normally, leaving an excess of glucose in the bloodstream. Diabetes leads to many health problems, like kidney failure, blindness, heart attacks and strokes. The Growing Prevalence of Diabetes It was interesting but sad for me to learn about the increased prevalence of diabetes in North America and around the world. Loren commented that diabetes was a specialized niche area in endocrinology when he began his research in this field over 25 years ago, but it is now a major area of study in medical research because of its epidemic proportions. Continue reading >>

Eaqs Chapter 16 Fluid And Electrolytes Flashcards Preview

Eaqs Chapter 16 Fluid And Electrolytes Flashcards Preview

Hyperkalemia is a condition in which there is an abnormal increase of potassium in the blood. Renal failure may cause hyperkalemia, because the kidneys cannot remove potassium from the body. Adrenal insufficiency causes aldosterone deficiency, which leads to the retention of potassium ions and also may result in hyperkalemia. Alkalosis is seen in hypocalcemia. Low blood volume and a large urine volume can result in hypokalemia. The nurse is reviewing the serum potassium results for a patient. What level best supports the rationale for administering a stat dose of potassium chloride 20 mEq in 250 mL of normal saline over two hours? The normal range for serum potassium is 3.5 to 5.0 mEq/L. This intravenous (IV) prescription provides a substantial amount of potassium. Thus the patient's potassium level must be low. The only low value shown is 3.1 mEq/L; 3.9 mEq/L, 4.6 mEq/L, and 5.3 mEq/L are not low values. A patient's ECG tracing has a short QT interval and a high peaked T wave. Which prescription should the nurse question? Sodium polystyrene sulfonate 30 grams by mouth 10 units regular insulin IVP and one-half ampule D50W IVP 2 grams calcium gluconate intravenous (IV) administered over two minutes A short QT interval and a high peaked T wave are indicative of hyperkalemia. The prudent nurse should question any prescription that could increase the potassium level in the patient. IV insulin with D50W and calcium gluconate are given to force the potassium back into the cells, temporarily correcting the hyperkalemia. Polystyrene sulfonate binds with potassium in the gastrointestinal (GI) tract and excretes it via feces. The nurse is providing care to a patient with hypocalcemia. Which clinical manifestation should the nurse anticipate for this patient? A prolonged QT segme Continue reading >>

Diabetes Mellitus And Polyuria

Diabetes Mellitus And Polyuria

Diabetes comes from the Greek word which means “siphon”. There are two distinct disorders that share the first name diabetes: diabetes mellitus and diabetes insipidus. This is because both disorders cause polyuria, or excessive urine output. Diabetes insipidus is a disorder of urine concentration which we will discuss in spring quarter. Diabetes mellitus is a disorder of blood glucose regulation, which results from a deficiency in the action of the hormone insulin. This may be due to autoimmune destruction of the insulin-secreting cells of the pancreas (type 1 diabetes mellitus) or it may result from a problem in the responsiveness of tissues to insulin, known as insulin resitance (type 2 diabetes mellitus). With either disorder, the result is hyperglycemia, or high levels of glucose in the plasma. How does hyperglycemia cause excessive urine production? To answer this, we need to understand a little bit about how the kidney works. Each kidney contains about a million functional units called nephrons (blue structure in the figure). The first step in the production of urine is a process called filtration (green arrow). In filtration, there is bulk flow of water and small molecules from the plasma into Bowman’s capsule (the first part of the nephron). Because of the nonspecific nature of filtration, useful small molecules such as glucose, amino acids, and certain ions end up in the forming urine, which flows into the kidney tubules. To prevent the loss of these useful substances from the body, the cells lining the kidney tubules use epithelial transport to transfer these substances out of the forming urine and back into the extracellular fluid. This process is known as reabsorption (purple arrows). Under normal circumstances, 100% of the glucose that is filtered is Continue reading >>

Diabetes Mellitus - An Overview | Sciencedirect Topics

Diabetes Mellitus - An Overview | Sciencedirect Topics

Diabetes mellitus (DM) is best defined as a syndrome characterized by inappropriate fasting or postprandial hyperglycemia, caused by absolute or relative insulin deficiency and its metabolic consequences, which include disturbed metabolism of protein and fat. Stanley F. Malamed DDS, ... Daniel L. Orr DDS, MS (ANES), PHD, JD, MD, in Medical Emergencies in the Dental Office (Seventh Edition) , 2015 Gestational diabetes mellitus is characterized by an abnormal result on the oral glucose tolerance test taken during pregnancy that either reverts back to normal in the postpartum period or remains abnormal.3 The clinical pathogenesis of gestational diabetes mellitus is similar to that of type 2 diabetes mellitus, while the clinical presentation is usually nonketotic hyperglycemia during pregnancy. Undiagnosed and untreated gestational diabetes mellitus carries significant risks of perinatal illness and death in all levels of disease severity, which may not be apparent in nondiabetic patients and those whose gestational diabetes mellitus is diagnosed and treated in a timely and effective manner.49,50 Approximately 18% of pregnancies are affected by gestational diabetes.4 Alan J. Sinclair, Simon C.M. Croxson, in Brocklehurst's Textbook of Geriatric Medicine and Gerontology (Seventh Edition) , 2010 Diabetic patients have a twofold to threefold increase in the rate of cerebrovascular accidents or myocardial infarctions, and have a worse outcome than nondiabetic people from either myocardial infarction or stroke.227 Aspirin should be used as secondary prophylaxis in all diabetic people with evidence of macrovascular disease, and it should be strongly considered as primary prevention in diabetic subjects with other risk factors for macrovascular disease, such as hypertension, cigar Continue reading >>

What Other Mechanisms Does The Body Have To Del With

What Other Mechanisms Does The Body Have To Del With

What other mechanisms does the body have to del with fluid and electrolyte What other mechanisms does the body have to del with 100% (10) 10 out of 10 people found this document helpful This preview shows page 2 - 4 out of 4 pages. 7.What other mechanisms does the body have to del with fluid and electrolyte imbalances? 8.What symptoms might result from hypernatremia?1.What is the underlying problem in a person with type 1 diabetes?2.How does this explain her elevated blood glucose levels?3.Given her elevated blood glucose levels, and your understanding of osmosis, explain her polyuria.Each kidney contains about a million functional units called nephrons (blue structure in the figure). The first step in the production of urine is a process called filtration (green arrow). In filtration, there is bulk flow of water and small molecules from the plasma into Bowmans capsule (the first part of the nephron). Because of the nonspecific nature of filtration, useful small molecules such as glucose, amino acids, and certain ions end up in the forming urine, which flows into the kidney tubules. To prevent the loss of these useful substances from the Continue reading >>

New Human Physiology | Paulev-zubieta 2nd Edition

New Human Physiology | Paulev-zubieta 2nd Edition

The kidneys transport substances by three vectorial processes. Vectorial processes are characterized by their direction and size only (Fig. 25-1). Fig. 25-1 : Renal transport. Black arrows indicate three vectorial transporting processes in a nephron: 1. Glomerular ultrafiltration is caused by a hydrostatic/colloid osmotic pressure gradient (the Starling forces), 2. Tubular reabsorption is the net movement of water and solute from the tubular lumen to the tubule cells and to the peritubular capillaries, and 3. Tubular secretion represents the net addition of solute to the tubular fluid. The final excretion rate of the substance s in the urine is called net-flux, Js, in Fig. 25-1. The functional unit is the nephron. Each human kidney contains 1 million units at birth. Each nephron consists of a glomerulus (ie, many glomerular capillaries in a Bowman's capsule), a proximal tubule forming several coils (pars convoluta) before ending in a straight segment (pars recta), the thin part of the Henle loop and a distal tubule also with a pars recta and a pars convoluta. The distal tubule ends in a collecting duct together with tubules from several other nephrons. The kidney (average normal weight 150 g) consists of a cortex and a medulla. The medulla is composed of renal pyramids, the base of which originates at the corticomedullary junction. Each pyramid consists of an inner zone (the papilla) and an outer zone. The outer zone is divided into the outer medullary ray and the inner ray. The rays consist of collecting ducts and thick ascending limbs of the nephron. A kidney lobulus is a medullary ray with adjacent cortical tissue. A kidney lobule is a pyramid with adjacent cortical tissue. The loop of Henle is a regulating unit. Actually, the Henle loop consists of the proximal par Continue reading >>

Full Text Of

Full Text Of "chapter 01 Clinical Chemistry"

CHAPTER Clinical Chemistry Outline 2 > Instrumentation and Analytical Principles > Proteins and Tumor Markers > Nonprotein Nitrogenous Compounds >* Carbohydrates >- Lipids and Lipoproteins >- Enzymes and Cardiac Assessment >* Liver Function and Porphyrin Formation V Electrolytes and Osmolality > Acid-Base Metabolism >* Endocrinology >- Therapeutic Drug Monitoring >* Toxicology Vitamins Review Questions 95 Answers & Rationales 1 45 References 228 Note: The reference ranges used throughout the book are meant to function as guides to understand and relate to the analytes; each laboratory facility will have established its own reference ranges based on the laboratory's specific instrumentation, methods, population, and so on. 1 tents 2 CHAPTER 1: CLINICAL CHEMISTRY I. INSTRUMENTATION AND ANALYTICAL PRINCIPLES A. Spectrophotometry General Information 1 . Electromagnetic radiation has wave-like and particle-like properties. a. Radiant energy is characterized as a spectrum from short wavelength to long wavelength: cosmic, gamma rays, X-rays, ultraviolet, visible, infrared, microwaves, radiowaves. b. Wavelength (\) is the distance traveled by one complete wave cycle (distance between two successive crests) measured in nanometers (nm). c. The shorter the wavelength, the greater the energy contained in the light, and the greater the number of photons. d. Light is classified according to its wavelength: Ultraviolet (UV) light has very short wavelengths and infrared (IR) light has very long wavelengths. When all visible wavelengths of light (400-700 nm) are combined, white light results. 1) Visible color: wavelength of light transmitted (not absorbed) by an object 2. Particles of light are called photons. When an atom absorbs a photon, the atom becomes excited in one of three ways Continue reading >>

Diabetes Mellitus (dm)

Diabetes Mellitus (dm)

Years of poorly controlled hyperglycemia lead to multiple, primarily vascular complications that affect small vessels (microvascular), large vessels (macrovascular), or both. (For additional detail, see Complications of Diabetes Mellitus.) Microvascular disease underlies 3 common and devastating manifestations of diabetes mellitus: Microvascular disease may also impair skin healing, so that even minor breaks in skin integrity can develop into deeper ulcers and easily become infected, particularly in the lower extremities. Intensive control of plasma glucose can prevent or delay many of these complications but may not reverse them once established. Macrovascular disease involves atherosclerosis of large vessels, which can lead to Immune dysfunction is another major complication and develops from the direct effects of hyperglycemia on cellular immunity. Patients with diabetes mellitus are particularly susceptible to bacterial and fungal infections. Continue reading >>

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