[Verified Answer]: Case Study #2 Linda D., a 13-year old girl…

Case Study #2 Linda D., a 13-year old girl who was a known diabetic, became comatose and was rushed to the hospital by her parents. Two days before admission, she went to school feeling ill and vomited that evening. Linda’s vomiting persisted with only a 6-hour pause during sleep. She refused to taker her insulin the following morning, even after she had been instructed to give herself the regular insulin dose and control her nausea with Tigan (trimethobenzamide HCL). The emergency room (ER) physician noted that she was breathing deeply and rapidly and that her breath had a fruity odor. The laboratory results are shown in Tables 2-1 through 2-3. Linda D. Reference Range Macroscopic Results Color Straw Colorless – Amber Appearance Clear Clear Specific Gravity 1.014 1.001 – 1.035 Table 2-1 Chemistry Results Linda D. Reference Range Glucose 430 70-105 mg/dL BUN 43 8-26 mg/dL Creatinine 2.6 0.6-1.2 mg/dL Sodium 129 136-145 mmol/L Potassium 5.8 3.5-5.0 mmol/L Chloride 88 99-109 mmol/L Total CO2 21-28 21-28 mmol/L HCO3 22-28 22-28 mmol/L Cholesterol 525 < 200 mg/dL Triglyceride 3800 < 250 mg/dL Table 2-2 Urinalysis Results Linda D. Reference Range pH 6.0 5.0 - 7.0 Protein Negative Negative Glucose 3 Negative Ketones 3 Negative Bilirubin Negative Negative Blood Negative Negative Urobilinogen Normal Normal Nitrite Negative Negative Leukocyte Esterase Negative Negative Macroscopic Results WBC’s 0-2 / HPF 0-5 / HPF RBC’s 0-1 / LPF 0-2 / HPF Epithelial Cells Few squamous / HPF Few - Moderate Casts Negative Few Hyaline Casts Bacteria None Seen None Seen Abbreviations: HPF = high-power field; RBC’s = red blood cells; WBC’s = white blood cells Linds D. Reference Range WBC 11.0 5.0 - 10.0 x 10 / L RBC 5.80 4.0 - 5.0 x 10 / L Hemoglobin 15.4 12.0 - 16.0 mg/dL Hematocrit 46% 36-46 % MCV 88 80-100 Table 2-3 Complete Blood Count Without Differential Linds D. Reference Range MCH 29 26-34 MCHC 35 31-37 Platelets 357,000 150,000 - 450,000 /L Questions 1. What are the abnormal laboratory results ? 2. What is Linda’s clinical condition and what caused the condition? 3. What is the typical arterial blood gas profile in this acid-base balance? What triggered her abnormal breathing (deeply and rapidly)? 4. Calculate the osmolality from the laboratory data. Is it increased, decreased, or normal? 5. What are the two possible explanations for the elevated BUN and creatinine in this patient? 6. Calculate the anion gap. What is the cause of this abnormal calculated anion gap?