Case Study

Case 1

A 60-year old patient M. was admitted to hospital in an unconscious state. On examination: the skin appears dry, turgor of the skin and eye ball is reduced; shallow breathing; heart rate 96 beats/min; the tongue is dry; recurrent cramps of the extremities and face muscles. Blood tests show hyperglycemia: 33 mmol/l, hyperazotemia, hypernatremia, pH 7.32.

The relative who accompanied the patient to hospital told the physician that the patient had been suffering from diabetes mellitus and had ingested small doses of hypoglycemic medicines. During the last month he experienced exacerbation of chronic cholecystitis and colitis, suffered from vomiting and diarrhea which occurred quite often. The patient also constantly felt thirsty and frequently urinated.

Questions:

Define the pathologic state of the patient on admission.

What was the cause of this pathologic state? Describe the main stages of its pathogenesis.

Why do patients lose consciousness during the development of this pathologic state and the similar ones?

What methods are used to treat patients in this pathologic state?

Case 2

A 28-year-old male patient visited his physician with complaints of intermittent muscle weakness, dizziness, headache, loss of vision, tremor of hands, and, occasionally, confusion and unprovoked aggressiveness. The paroxysms of this condition became more frequent during the last 4 months. The patient attributed his illness to the problems connected with his professional activity, and also associated it with an acute feeling of hunger. The patient's evaluation resulted in the diagnosis of neurasthenia and he was prescribed a corresponding treatment. However, the disease went on progressing, and 1.5 months later the patient was brought by ambulance to the emergency room with a diagnosis of coma of unclear etiology.

On admission: consciousness is lost; there is evidence of midriasis, muscle cramps; tachycardia, arterial hypotension; irregular breathing; blood glucose level 30 mg/dl.

Questions:

What form of pathology underlies the clinical manifestations presented by the patient during his first visit to the physician? Substantiate your answer.

Define the pathologic state of the patient in the emergency room.

What are the main steps of pathogenesis of this pathologic state?

What other forms of pathology should be kept in mind when you are making a differential diagnosis of this pathologic state?

Case 3

A 45 year-old patient E. with an excessive body mass suffers from diabetes mellitus. For this reason he uses hypoglycemic drugs. Two weeks before he was admitted to hospital he had had an episode of alcohol abuse, and soon after that noticed an enhanced feeling of dry mouth; drank a lot of water (up to 8-10 L daily); urinated more often than usually. He felt general weakness and pain in the legs. On the night before the admission the patient was delirious. When he woke up in the morning he was agitated, restless, and confused. The patient's relatives called in the ambulance. On admission: consciousness is absent; the skin is dry and pale. The results of the blood tests: glucose 55 mmol/l, lactic acid 29 mg/dl, pH 7.29. Urine glucose level 4 mg/dl.

Questions: