Microbiology Fundamentals 2nd Edition by Jennifer Bunn,Marjorie Kelly Cowan

تمرين 1

C A S E F IL E

Not So Sweet
was working in triage in the emergency room of a pediatrics hospital during my final nursing practicum when a mother and her 8-year-old daughter came in. The mother stated that her daughter had been ill for 3 days with nausea and vomiting. She had been unable to keep any food or fluids down during this time, although she complained of constant thirst and begged for water and juice. The mother was concerned that her daughter was becoming dehydrated. I quickly assessed the little girl and found that she did not have a fever (although her skin was flushed and hot), her heart rate was fast (125 beats per minute), and her blood pressure was low at 88/56 mmHg. Her respirations were fast, deep, and labored. She was very pale and her lips were cracked. She complained that her "tummy" hurt and she was quite drowsy, seeming to fall asleep whenever I was not touching or talking to her. Her breath had an odd odor-it was almost sweet, which seemed at odds with a 3-day history of vomiting.
Concerned because the patient appeared to be very ill, I notified my preceptor, who quickly came to assess the little girl. We notified the doctor, who also came quickly. We started an intravenous line so we could rehydrate the patient and drew blood for laboratory tests at the same time. The physician requested a spot glucose, so I poked the patient's finger to obtain a drop of blood and applied it to a glucose monitor. The result on the monitor read "HHH." Concerned that I had not performed the test properly, I showed the result to the physician, who said that that was the result he expected. My supervisor explained that "HHH" meant that the patient's blood sugar was too high for the monitor to read and that was all the information we needed to confirm the patient's diagnosis. She asked me if I had noticed the patient's breathing pattern and her odd sweet-smelling breath. I said that I had, and all of a sudden the patient's symptoms came together in my mind. I knew what was wrong with the patient-it was diabetic ketoacidosis.
• What is catabolism, and how does it relate to the patient's symptoms?
• When the body lacks insulin and cannot burn glucose for energy, what does the body use as fuel instead?