2015-08-13
254
What are the main stages of the pathogenesis of hyperosmolar coma?
What are the main principles of therapy for diabetic hyperosmolar coma?
Case 4
A female patient, approximately 40-years of age, has been brought to the emergency room in an unconscious state. Witnesses of the incident told the physician that she had suddenly lost her consciousness in the bus on her way back from her summer house in the countryside. A card that was found among her papers indicated that she suffered from diabetes mellitus and took a slow-release form of insulin.
On examination: consciousness is absent, corneal and deep tendon reflexes are not observed, the pattern of breathing is unremarkable; blood pressure 80/60 mm Hg; tachycardia is present; the skin appears moist; turgor of the eye balls is increased; general trembling is alternating with episodes of clonic and tonic spells.
The patient was treated with insulin, but no improvement was observed; the patient's condition even worsened: breathing became irregular, blood pressure decreased to 70/50 mm Hg, tachycardia progressed, and the duration of seizures increased.
Questions:
What pathologic state developed in the patient before and after administration of insulin? Describe causes and mechanisms of this state.
What therapeutic procedure would have been appropriate to treat the patient for her condition before and after the administration of insulin?
Case 5
On examination the patient A.: fasting blood glucose level is 7.26 mmol / l. Level of C-peptide is increased. Insulin concentration is increased. Glycated hemoglobin increased.
Explain the term Glycated hemoglobin.
What diagnostic value has C-peptide?
What form of pathology is it?
Case 6
A person was fasting for 10 days (fasting with water). Daily blood glucose concentration was determined. Glycemia during the fasting period remained within the lower limit of normal.
Explain the mechanism of normoglycemia at the person.
Case 7
A 61-year-old female patient has been suffering from arterial hypertension for many years. During the last 2 years she began to feel cold intolerance in the legs; numbness and pain in the gastrocnemius muscles when walking, and then at rest. These symptoms were more intense at night and caused sleep disturbances. Six months ago she developed a skin lesion on the front surface of her right shin; later it transformed into ulcer. The ulcer was painless but resistant to therapy. During the visit to the doctor the patient complained of dryness in the mouth, constant feeling thirsty, frequent urination. On examination: the skin of the right shin was dry, pale, and cold; no pulsation of the sole artery was detected. Repeated blood tests showed increased levels of cholesterol, fibrinogen; high platelet counts; glucose 190-210 mg/dl. The urine is positive for ketone bodies and glucose.
Questions:
