Week 2 PBL

Question 1

What is Kussmaul breathing

Answer 1

deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic keto-acidosis

form of hyperventilation

at first it is rapid and shallow, but as acidosis worsens, becomes deep, slow, labored, gasping

respiratory compensation for metabolic acidosis

Question 2

How does insulin deficiency result in keto-acidosis

Answer 2

1. no circulating insulin–>body acts as if it is starving and produces ketone bodies for fuel (fat metabolism)
2. insulin normally inhibits the production of ketones from lipolysis, but without insulin, the body does it
3. ketone bodies include beta-hydroxybutarate and acetoacetate
4. if produced in excess, leads to lower pH (acidosis)
5. respiration is stimulated to compensate (to decrease pCO2)

Question 3

Describe the ECG changes seen in hyperkalemia

Answer 3

1. TALL T WAVES
2. prolonged PR interval
3. widening of QRS complex
4. “sine wave” pattern
5. ventricular fibrillation
6. cardiac arrest

Question 4

When present in a diabetic patient, what does proteinuria suggest?

Answer 4

suggest the development of diabetic nephropathy

the earliest clinical manifestation of nephropathy is the presence of small but abnormal levels of albumin in the urine (microalbuminuria)–generally preceeds overt proteinuria by about 5-10 years

proposed mechanism: diabetic damage to the glomerulus allows more protein to be filtered–> because of higher filtered load, reabsorption methods by endocytosis are saturated, and therefore there is more protein excreted out of the kidneys