Page 583 - Concise Pathology for Exam Preparation ( PDFDrive )

568 SECTION II Diseases of Organ Systems

Q. Differentiate between DKA and HHNS.

Ans. Differentiating features of DKA and HHNS have been listed in Table 20.4.

TABLE 20.4. Diagnostic criteria and typical total body deficits in DKA and HHNS

Diagnostic criteria DKA HHNS
Plasma glucose (mg/dL) .250 .600
Arterial pH ,7.00 .7.30
Serum bicarbonate (mEq/L) ,10 .15
Urine ketones Marked increase Mild increase, if any
Serum ketones Positive Small amounts
Effective serum osmolarity ,320 .330
Mental status Drowsy stupor/coma Variable
Serum sodium (mEq/L) Usually low Normal, increased or low
Serum potassium (mEq/L) Normal, increased or Normal or increased
low
Serum phosphorus (mEq/L) Normal or increased Normal or increased
Serum magnesium (mEq/L) Normal or increased Normal or increased
Serum lactate (mmol/L) 2–3 1–2
Blood urea nitrogen (BUN) Less increase Greater increase

Q. Define a potential diabetic.
Ans. Potential diabetics are persons with a normal glucose tolerance test, who have an
increased risk of developing diabetes for genetic reasons.
Examples
• Children of two diabetic parents
• Sibling of a diabetic
• Nondiabetic member of a pair of monozygotic twins where the other is a diabetic
Q. Define a latent diabetic.

Ans. Latent diabetics are persons in whom the glucose tolerance test is normal but who are
known to have given an abnormal result under conditions imposing a burden on the pancreatic
cells, eg, during pregnancy, infection, severe stress (physical or mental), during treatment with
corticosteroids, thiazide diuretics or other diabetogenic drugs or when overweight.

Q. What is glycosuria?
Ans. Glycosuria occurs when blood glucose level exceeds the renal glucose threshold of
180 mg/dL. Glycosuria can be secondary to hyperglycaemia (diabetes mellitus) or nondia-
betic in origin. Nondiabetic glycosuria can be
1. Renal glycosuria: Glycosuria in the absence of hyperglycaemia due to a lowered renal
threshold for glucose.
2. Alimentary (lag storage) glycosuria: There is a transient abnormal rise in blood glu-
cose level following a meal, and the concentration exceeds the normal renal threshold.
During this time, glucose spills into the urine. This may occur in patients undergoing
gastric surgery resulting in rapid gastric emptying, hyperthyroidism or hepatic diseases.

Q. What is gestation diabetes?
Ans. This class of patients is defined as women in whom during pregnancy diabetes or IGT
become manifest. After pregnancy, the condition usually reverses to normal; but in some
patients diabetes or IGT persists. Untreated gestational diabetes can damage health of fetus
or mother. Risks to baby include macrosomia (high birth weight); congenital cardiac, cen-
tral nervous system and skeletal muscle malformations; respiratory distress syndrome; and
red blood cell destruction leading to jaundice.

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