Case 5 Endocrine

Scott, a 17-year-old high school football player, was brought to the hospital emergency room in a coma. According to his mother, he had lost weight during the last month in spite of eating large amounts of food. Besides losing weight, he was excessively thirsty and had frequently awakened his younger brother as he noisily voided several times during the night. The family history revealed others with diabetes mellitus. Physical examination was not significant except for tachycardia and hyperpnea.

Laboratory serum studies revealed the following:

Glucose on admission 510 mg/dL

pH = 7.25

pCO₂ = 30 mm Hg

HCO-₃ = 12 mEq/L

Ketones = 4+

Glycosylated hemoglobin = 9%

1. Discuss the pathophysiological changes that occur with diabetes mellitus specifically addressing each laboratory value identifying if it is high, low or normal and a rationale for results.

2. What factors from Scott’s history validate your diagnosis of diabetes mellitus?