1. Two symptoms ofdiabetes mellitus are hyperglycemia (elevated blood sugar) anddiuresis (elevated urine output). What causes these toincrease?

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Beverley SmithLv2

28 Sep 2019

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1.) Give an example of a buffer system that works in the blood plasma and a different buffer system that works in the urine. Why is it so important to buffer the urine pH?
2.) What are the general limitations of buffers?
3.) How does each of these systems (blood buffer and urine buffer) respond to 1) elevated H+ concentration and 2) decreased H+ concentration?

Case 1

John Smith, a patient with long-standing history of type 2 diabetes mellitus, has been feeling progressively weaker over the past few months. She has also been feeling generally ill, and has been gaining weight although she has not changed her eating habits. During her routine visit to her family doctor, some standard blood and urine tests are ordered as an initial evaluation. In addition, her previously diagnosed mild high blood pressure has gotten significantly worse. The physician is concerned when the testing shows an increase in levels of creatinine in her blood and microalbumin in her urine. The patient is referred to a nephrologist for further evaluation.

1) What disease condition is John Smith suffering from? Explain the pathophysiology and symptoms associated with this disease state?

2) Discuss the various laboratory tests done to diagnose this disorder.

3) Describe the biochemical phenomenon that is responsible for vascular complications associated with chronically elevated levels of glucose in the circulation.

A 52-year-old man was brought to the local hospital emergency department by his brother. The man had notable ascites of the abdomen and was breathing erratically. His history showed that he had abused alcohol in the past, but he now considered himself recovered. Blood samples were taken and the following results were obtained: total protein, decreased; albumin, decreased; g-glutamyl transferase (GGT), extremely elevated; alkaline phosphatase (ALP), increased; aspartate transaminase, normal; alanine transaminase (ALT), elevated; serum creatinine and urea, extremely elevated; serum sodium, decreased; prothrombin time, increased. Blood gas analysis was performed with the following results: pH 7.2; bicarbonate, decreased; Pco₂ elevated. The man was admitted immediately to the intensive care unit of the hospital.

Questions:

1.What is the most likely diagnosis for this individual? (2 pts)

2.How do the laboratory results support this diagnosis? (5 pts)

3.What organ systems are involved in the appearance of the symptoms? (3 pts)

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1. Two symptoms ofdiabetes mellitus are hyperglycemia (elevated blood sugar) anddiuresis (elevated urine output). What causes these toincrease?

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