Mr. Gutteman, a 70-year-old male, was brought into the ER. He had been sick several days with the flu, and was found confused and barely conscious by his daughter.
Mr. Gutteman is breathing rapidly and has a fever of 39°C (102°F). His skin is dry and flaccid, his mucous membranes are dry, and his eyes are sunken. The physician ordered:
• IV (intravenous) fluid and electrolyte replacement
• Blood and urine tests for presence of glucose and ketones
• Strict I&O [careful measurement of fluid intake (e.g., IV, drinking) and output (e.g., urine)]
Give some thought to Mr. Gutteman’s signs and symptoms and discuss your assessment of his injuries. Address the following questions in your assessment:
1. You would expect high levels of blood glucose and the presence of glucose and ketones in Mr. Gutteman’s urine if:
a. His pancreas is secreting too much insulin
b. His liver is secreting too little insulin
c. His pancreas is secreting too little insulin
d. His liver is secreting too much glucagon
Mr. Gutteman’s blood and urine tests are negative for glucose and ketones. However, Mr. Gutteman is losing large amounts of water in urine, and the volume lost is being replaced (via IV).
2. Given this new information, Mr. Gutteman’s excessive fluid loss in his urine most likely indicates:
a. An increased blood level of aldosterone
b. A decreased blood level of antidiuretic hormone
c. An increased blood level of antidiuretic hormone
d. A decreased blood level of insulin
3.
Mr. Gutteman’s diagnosis is diabetes insipidus. His daughter is concerned about this, because she knows diabetes is a dangerous disease. She asks whether he will have to follow a diabetic diet.
What’s your answer?
4. Is diabetes insipidus life threatening? Explain your answer.
Justify your thinking and be sure to reference any content from the text and/or outside resources.