A 16-year-old boy is brought to the emergency department because of confusion, fatigue, and abdominal pain. He has also experienced excessive thirst and polyuria during the last 3 weeks. His past medical history is insignificant. Family history is unremarkable. Urine dipstick is positive for glucose and ketones. Which of the following factors most likely contributed to the development of this patient's condition?

Question

A 16-year-old boy is brought to the emergency department because of confusion, fatigue, and abdominal pain.  He has also experienced excessive thirst and polyuria during the last 3 weeks.  His past medical history is insignificant.  Family history is unremarkable.  Urine dipstick is positive for glucose and ketones.  Which of the following factors most likely contributed to the development of this patient's condition?

Quizplus · Accepted Answer

11ec160b_3912_13fb_9249_e906af79845e_MD0001_00 This patient is presenting with diabetic ketoacidosis, a condition that most commonly affects patients with type 1 diabetes mellitus due to their absolute insulin deficiency. Type 1 diabetes mellitus occurs in genetically susceptible individuals who are exposed to triggering environmental factors (eg, viral infections, environmental toxins, dietary components). This results in an autoimmune response against pancreatic beta cells that leads to progressive loss of beta cell mass. Overt manifestations of diabetes mellitus tend to develop once >90% of beta cells are destroyed. Although antibodies against islet antigens are detected in a large number of patients, they are thought to play a permissive role in disease pathogenesis; the destruction of beta cells occurs primarily through cell-mediated immunity. Infiltration of islets by inflammatory cells is called insulitis and is more prominent during the early stages of disease. (Choices A and B) Abdominal fat deposition and excessive body weight are important contributors to insulin resistance and development of type 2 diabetes mellitus. Intra-abdominal visceral fat is more strongly related to insulin resistance than is subcutaneous fat. (Choice C) Maturity-onset diabetes of the young is an autosomal dominant disease caused by mutations that impair glucose sensing and insulin secretion by pancreatic beta cells. It presents as non-insulin-dependent diabetes at a young age (<25) and accounts for <5% of all cases of diabetes mellitus. (Choice D) Islet amyloid polypeptide is secreted along with insulin from pancreatic beta cells. Amyloid deposition occurs in the islets of patients with type 2 diabetes mellitus, although its role as a causative agent of beta cell dysfunction remains unknown. Patients with type 1 diabetes mellitus have low circulating levels of islet amyloid polypeptide due to extensive beta cell destruction. Educational objective: Autoimmune insulitis with progressive beta cell loss is the most common cause of type 1 diabetes mellitus. Insulin resistance accompanied by relative insulin deficiency is the main cause of type 2 diabetes mellitus. __________ References: Advances in the cellular immunological pathogenesis of type 1 diabetes. (http://www.ncbi.nlm.nih.gov/pubmed/24629100)

A 16-Year-Old Boy Is Brought to the Emergency Department Because