Discuss all abnormal results and explain the underlying

Question

Discuss all abnormal results and explain the underlying cause/s of each abnormal laboratory result.

Ram Kumar · Accepted Answer

The high glucose in the blood due to insufficient insulin leads to the starving of the cells, so the body begins to break down fat to get energy. One of the breakdown products of fat is ketone bodies. Metabolic acidosis in DKA is caused by an excess of beta-hydroxybutyric acid and acetoacetic acid. These two ketoacids totally disintegrate, and the excess hydrogen ions bind to the bicarbonate, resulting in lower plasma bicarbonate levels. As a result, ketone bodies circulate in the anionic form, resulting in anion gap acidosis. Thus, the patient has low pH, low HCO3, high glucose levels, and high ketone levels. DKA is associated with hyperglycemia, hyperketonemia, and metabolic acidosis. Metabolic acidosis will cause hyperventilation by stimulating the respiratory center in the brain's cortex region, resulting in a decrease in carbon dioxide partial pressure. This will partially compensate for metabolic acidosis. This explains the low PCO2 in arterial blood gas. In response to metabolic acidosis due to the low level of bicarbonate, more H+ ion moves into the cell cytoplasm, and potassium moves out of the cell cytoplasm and into extracellular fluid and plasma leading to elevated plasma potassium concentration and much of it is excreted in the urine. This explains elevated plasma potassium. The increased glucose concentration in the extracellular fluid due to diabetes forces water out of intracellular fluid to extracellular fluid, leading to the dilution of the plasma sodium level. This explains the normal or low plasma sodium level. DKA is typically accompanied by dehydration, resulting in prerenal azotemia, in which BUN (Blood Urea Nitrogen) levels are raised more than blood creatinine levels. Due to dehydration, the hypothalamus increases the level of ADH to increase water reabsorption. As a result, a large amount of urea is also reabsorbed into the plasma, raising the plasma urea level.

Discuss all abnormal results and explain the underlying cause/s of each abnormal laboratory result.

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