questionsto preparefor s c e- puzzle vex（questionsto preparefor s c e -难题烦恼）（13页）.docVIP

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2017-01-23 发布于四川
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questionsto preparefor s c e- puzzle vex（questionsto preparefor s c e -难题烦恼）（13页）.doc

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Questions to Prepare for OSCE 1. Describe the pathophysiologic changes in DKA. a. Why do blood glucose levels increase? - Without insulin, the amount of glucose entering the cells is reduced, so then the liver increases glucose production The patient lacks insulin which is required to breakdown sugar for energy. This results in an increase in glucose levels. b. What are commonly seen blood glucose levels? - Blood glucose levels may vary from 16.6 to 44.4 mmol/L. Some may have lower, and others may have values of 55.5mmol/L c. What fluid and electrolyte disturbances commonly occur? -Water, sodium, potassium, and chloride d. What causes the fluid and electrolyte disturbances? -In an attempt to rid the body of the excess glucose, the kidneys excrete the glucose along with water and electrolytes. Patients with DKA may lose up to 6.5 litres of water and up o 400 to 500 mmol/L each of sodium, potassium, and chloride. Due to the lack of insulin, cells are not receiving an adequate fuel source to produce energy. Even though the blood is loaded with glucose, the cells go into a starvation mode. This triggers the release of glucagon and other counter-regulatory hormones that promote the breakdown of triglycerides into free fatty acids and initiate gluconeogenesis to produce more glucose for the starving cells. This further elevates the blood glucose level as the body begins to metabolize protein and fat to produce a source of energy. Due to the insulin deficiency and release of large amounts of glucagon, free fatty acids circulate in abundance in the blood and are metabolized into acetoacetic acid and B-hydroxybutric acid — both of which are strong organic acids and are referred to as ketones. As acetoacetic acid is metabolized it produces acetone, which begins to accumulate in the blood. Small amounts of acetone are released in respiration and produce the characteristic “fruity breath” odor. In normal metabolism, ketones would be used as fuel in the peripheral tis