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Discussion Topic #4: Type 1 Diabetes & Acid/Base Homeostasis
Discussion Topic #4: Type 1 Diabetes & Acid/Base Homeostasis
Acid-Base Homeostasis: Type 1 Diabetes Patient Case Study
The link above is required reading using Oregon State University’s open source textbook for their Anatomy & Physiology course. This is a supplement to the acid-base regulation lecture discussions in Chapters 13 & 14 of our course.
The key here is that you have two systems, respiratory and renal, working together to address situations where acid/base homeostasis is disturbed.
Part 2: Clinical Case Study – Diabetic ketoacidosis
Read the case summary below and then answer the questions that follow.
Case: During your shift in the ER, a 21-year old noncompliant male with a history of type I (insulin-dependent) diabetes mellitus was found in a coma. Your triage assessment and the lab testing revealed the following:
- Hyperglycemia: High blood glucose.
- High urine glucose.
- High urine ketones and serum ketones.
- Low serum bicarbonate <12 mEq/L.
- Exaggerated respiration.
- Breath has acetone odor.
- Hypotensive: blood pressure was 90/60 mm Hg.
- Tachycardia: Pulse weak and rapid (120 bpm).
Based on your understanding of both the respiratory and renal regulation of blood pH, answer the following:
- Is this patient experiencing respiratory or metabolic acidosis?
- Based on your answer to #1, discuss the mechanism(s) which led to this complication.
- The formula below represents the respiratory & renal systems’ regulation of acid-base balance (remember that the enzyme carbonic anhydrase catalyzes the forward reaction between carbon dioxide and water).
CO2 + H2O ↔ H2CO3 ↔ H+ + HCO3–
Review this formula and discuss the mechanisms involved in the forward and reverse components of the reaction by answering the following:
- When CO2+ H2O combine to form carbonic acid, discuss the respiratory mechanisms involved to regulate the levels of CO2
- Explain why exaggerated respiration (increased ventilation) help to decrease the levels of H+
- When carbonic acid dissociates into free H++ HCO3– what role do the levels of bicarbonate play in regulating H+ ion levels?
- Discuss at least (2) of the renal mechanisms used to regulate HCO3–