Biochemistry Case Study Assignment

BIOCHEMISTRY CASE STUDY ASSIGNMENT NAME: RUKUNDO JEREMY REGISTRATION NUMBER: KM24B80/016 1. List all the questions that need to be answered, ideally starting with “What is a semi-colon?” or “Is diabetes more common in women or men?” Be as precise as you can. (10 minutes) 1. What is ketoacidosis? 2. What causes ketoacidosis in diabetes patients? 3. Why was Mrs. A.N. so dehydrated? 4. What are the biochemical features of ketoacidosis? 5. How is ketoacidosis diagnosed? 6. What are the symptoms of ketoacidosis? 7. What treatment options are available for ketoacidosis? 8. What role do insulin and glucose play in ketoacidosis? 9. How does ketoacidosis affect the body? 10. What are the normal plasma component levels? 11. How does the treatment given to Mrs. A.N. address her condition? 12. What was the rationale behind using specific treatments for Mrs. A.N.? 13. What is the role of electrolytes in ketoacidosis? 14. How does fluid therapy help in the treatment of ketoacidosis? 15. What are the long-term complications of untreated ketoacidosis? 16. What are the differences between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS)? 17. How can ketoacidosis be prevented in diabetic patients? 18. What are the common triggers for ketoacidosis in diabetic patients? (a) Mark “A” those 12-16 questions you consider most important for your un derstanding of ketoacidosis. For example, “What causes Mrs. A.N. to be s o dehydrated?” is more important in this context than “What antibiotics are used to treat urinary infections?” - Why was Mrs. A.N. so dehydrated? - What are the biochemical features of ketoacidosis? - What causes ketoacidosis in diabetes patients? - How is ketoacidosis diagnosed? - What are the symptoms of ketoacidosis? - What treatment options are available for ketoacidosis? - What role do insulin and glucose play in ketoacidosis? - How does ketoacidosis affect the body? - How does the treatment given to Mrs. A.N. address her condition? - What was the rationale behind using specific treatments for Mrs. A.N.? - What is the role of electrolytes in ketoacidosis? - How does fluid therapy help in the treatment of ketoacidosis? - What are the long-term complications of untreated ketoacidosis? - What are the differences between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS)? - How can ketoacidosis be prevented in diabetic patients? - What are the common triggers for ketoacidosis in diabetic patients? (b) Mark “B” the 4-8 questions (selected from the 12-16 questions above) you will try to answer in the next hour and allocate them amongst yourselves. Pay special attention to the biochemical features of this case, rather than to the bacteriological or physiological aspects. - What are the biochemical features of ketoacidosis? - What causes ketoacidosis in diabetes patients? - How is ketoacidosis diagnosed? - What are the symptoms of ketoacidosis? - What role do insulin and glucose play in ketoacidosis? - What treatment options are available for ketoacidosis? - Why was Mrs. A.N. so dehydrated? 3. Spend 60-70 minutes individually looking for and making notes on answers to the questions you identified in 2(b). - Biochemical Features of Ketoacidosis: High blood glucose levels, increased ketone bodies, low pH (acidosis), and electrolyte imbalances. - Causes in Diabetes Patients: Insulin deficiency, leading to high blood glucose levels and fatty acid breakdown, producing ketone bodies. - Diagnosis: Blood tests to measure glucose, ketone bodies, blood pH, and electrolyte levels. - Symptoms: Nausea, vomiting, abdominal pain, rapid breathing, fruity-scented breath, confusion, and dehydration. - Role of Insulin and Glucose: Insulin helps regulate blood glucose levels and prevents excessive ketone body production. - Treatment Options: Fluid replacement, insulin therapy, electrolyte correction, and monitoring of blood glucose and ketone levels. - Dehydration: Resulting from high blood glucose levels leading to osmotic diuresis and fluid loss. 4. Then convene as a group and assemble the information you have gathered. Write a short group report and leave it with the tutor before you go. (Reports will not be acceptable after the class). Probably each of you will have to write the part of the report dealing with the question you tried to answer. The report should: (i)List the questions you identified in Question 2 marked with A and B. (ii) Report on what you have been able to find out on the questions you selected in 2(b) above, and give your sources of information. When giving a source of information, you must be very precise. Here is an example: from Harper's Biochemistry, 22nded, R.K. Murray, P.A. Mayes, D.K. Granner, V.W. Rodwell. Prentice-Hall International, London, 1990, pages 212-306. (iii) Suggest, with your reason, what you think was the cause of the patient's attack of ketoacidosis. Explain the rationale of the treatment. Group Report 1. What are the biochemical features of ketoacidosis? Ketoacidosis is characterized by elevated blood glucose levels (hyperglycemia), high levels of ketone bodies (ketosis), low blood pH (acidosis), and significant electrolyte imbalances (like low sodium and high potassium). The presence of ketone bodies results from the breakdown of fatty acids due to insufficient insulin, leading to a state of metabolic acidosis. 2. What causes ketoacidosis in diabetes patients? Ketoacidosis in diabetes patients is primarily caused by an absolute or relative deficiency of insulin. This deficiency leads to increased blood glucose levels because glucose cannot enter cells for energy. Consequently, the body starts breaking down fatty acids for energy, producing ketone bodies as by-products. These ketone bodies accumulate in the blood, causing acidosis. Triggers include infections, missed insulin doses, or other stressors like surgery or trauma. 3. How is ketoacidosis diagnosed? Ketoacidosis is diagnosed through blood tests that measure: - Blood glucose levels (usually >250 mg/dL) - Ketone levels in blood or urine (positive for ketones) - Blood pH (typically <7.3) - Serum bicarbonate levels (typically <18 mEq/L) - Electrolyte levels, to assess imbalances (e.g., sodium, potassium) Additionally, patients may present with a combination of symptoms such as rapid breathing, fruity-scented breath, and signs of dehydration. 4. What are the symptoms of ketoacidosis? Common symptoms of ketoacidosis include: - Nausea and vomiting - Abdominal pain - Rapid, deep breathing (Kussmaul respirations) - Fruity-scented breath (due to acetone) - Fatigue and weakness - Confusion or altered mental status - Dehydration (dry mouth, excessive thirst, frequent urination) - Flushed skin 5. What role do insulin and glucose play in ketoacidosis? Insulin is a hormone that helps regulate blood glucose levels by allowing cells to take up glucose for energy. In ketoacidosis, the lack of insulin prevents glucose from entering cells, causing the body to break down fats for energy instead. This breakdown produces ketone bodies, which lead to acidosis. Administering insulin helps lower blood glucose levels, halts ketone production, and corrects metabolic acidosis. 6. What treatment options are available for ketoacidosis? Treatment for ketoacidosis typically includes: Fluid Replacement: Administering intravenous (IV) fluids to rehydrate and correct electrolyte imbalances. Insulin Therapy: IV insulin to lower blood glucose levels and stop ketone production. Electrolyte Replacement: Monitoring and correcting electrolyte imbalances, such as potassium levels. Monitoring: Regularly monitoring blood glucose, ketone levels, electrolytes, and blood pH to guide treatment and ensure recovery. 7. Why was Mrs. A.N. so dehydrated? Mrs. A.N.'s dehydration was likely due to osmotic diuresis caused by high blood glucose levels. When blood glucose levels are extremely high, the kidneys attempt to excrete excess glucose through urine. This leads to the loss of large amounts of water and electrolytes, resulting in significant dehydration. Dehydration is a common and dangerous complication of ketoacidosis. Sources: 1. Harper's Illustrated Biochemistry 2. Lehninger Principles of Biochemistry 3. Biochemistry by Jeremy M. Berg, John L. Tymoczko, and Lubert Stryer 4. Marks' Basic Medical Biochemistry: A Clinical Approach