Angeles University Foundation

Angeles City, Pampanga

Clinical Microscopy

Case Study Analysis

Group 6

Alagdon, Edsel

Gomez, Paul Arvin

Laus, Abigail

BSMT 3-A

Ms. Crizelda Liwanag

January 7, 2010
Case 10:

A 32-year old woman with a long history of IDDM has been checking her blood sugar at
home daily and administering her own insulin. On a rainy Sunday night, she was
admitted through the ER after 2 days of vomiting, upper abdominal pain, and right jaw
pain. Her admission diagnosis was Diabetic Ketoacidosis and dehydration. The
admission urinalysis (no microscopic) was significant for glucose >1000 mg/dL and
ketones >80 mg/dL. Her condition was resolved with fluid and electrolyte therapy and
insulin drip.

Guide Questions and Answers:

1. What urinalysis results correlate with the diagnosis of DKA?

Color Colorless

Odor Strong, sweet smell

pH Decreased

Protein Increased

Glucose Increased

Specific Gravity Increased

Ketones Present

2. Explain.

The color of the urine appears to be diluted, but the specific gravity is high due to the
increased glucose content. Excretion of ketone bodies in the urine is responsible for the
sweet smell of the urine. The production of ketone bodies increases the acidic nature of the
urine. The presence of sugar in the blood leads to its excretion in to urine. Ketones in the
urine mean the body is burning fat to get energy.

3. What results should be expected from the microscopic examination?

In patients with diabetes mellitus, fatty casts are observed during microscopic
examination of the urine.

10-item Sample Test Paper:

1. The urinalysis was significant because of:

a. Increased amount of glucose

b. Decreased amount of ketones

c. Presence of low specific gravity

 d. Increased pH

2. What sediment constituents may be seen from the microscopic examination?

a. RBC casts

b. WBC

c. Fatty casts

d. Bacteria

3. What may be the cause of the woman having diabetic ketoacidosis on her case?

a. Failure to administer insulin

b. High insulin intake

c. Drinking lots of electrolytes

d. Low glucose level

4. Which will show a correct urinalysis results for Diabetic ketoacidosis?

a. Odor – normal; pH – 7; protein – increased; glucose – normal; spec. gravity –

normal; ketones – negative

b. Odor –strong sweet; pH – decreased; protein – increased; glucose –increased; spec.

gravity –increased; ketones - present

c. Odor – normal; pH – decreased; protein – increased; glucose –increased; spec.

gravity – normal; ketones - negative

d. Odor –foul; pH – decreased; protein – increased; glucose – increased; spec. gravity

– normal; ketones - negative

e.

5. In the patient’s case, insulin level is low with type 1 Diabetes. What is the other name for
this type?

a. Insulin Sufficient Diabetes mellitus

b. Adequate insulin diabetes mellitus

c. Non-insulin dependent diabetes mellitus

d. Insulin dependent diabetes mellitus

6. The insulin level of the patient is low because of:

a. Excessive urination and sweating

b. Her immune system destroys some beta cells in the pancreas

c. Her kidney is swelling

d. High glucose level

7. What organ of the body is responsible for the insulin problem in type 1 diabetes?

a. Kidney
 b. Pancreas

c. Spleen

d. gallbladder

8. In the absence of glucose, most cells use this to produce ATP for energy production:

a. Fatty acids

b. Sucrose

c. Protein

d. Cells don’t use energy at all

9. Fatty acid breakdown causes:

a. Bad cholesterol production

b. Release of glucose

c. Fatty acid accumulation

d. Ketone production and accumulation

10. It is a condition among Diabetes patients wherein insulin deficiency or resistance causes
the pulling of fluid body tissues leading to polyuria and dehydration

a. Hyperglucosemia

b. Polyuria

c. Hyperglycemia

d. Metabolic acidosis

Answer Key:

1. A

2. C

3. A

4. B

5. D

6. B

7. B

8. A

9. D

10. C

Pertinent Information:
Autoimmune diseases are diseases that occur because of the body’s immune system attacking
its own cells and rendering a function useless as is the case in diabetes. In diabetes, the killer T
cells of the body attack the insulin producing cells of the pancreas; thereby, shutting down the
production of insulin. When the production of insulin is affected, the body cannot control the
amount of sugar in the blood and this sugar is even excreted in the urine. The liver then starts to
produce ketone bodies as a response to the low insulin level, which the body is fooled into
thinking that, it is because of a low intake of glucose. The production of ketone bodies then
increases the acidic nature of the blood, because ketones are created from fatty acids and the
adipose stores in the liver. At a certain pH level that indicates high acidity, the tissues of the
body start to die and the breath of diabetes patient has a sweet, alcoholic smell that emergency
room doctors immediately recognize as the symptom of diabetic ketoacidosis. This condition is
potentially fatal if not treated on time.

The presence of sugar in the blood leads to its excretion into urine, which is due to the
overloading of certain binding proteins in the kidneys that send back glucose into the blood in
normal circumstances. Urine that usually contains glucose and sugars has a sweet, fruity smell.
However it is an indication that you need to rush to the emergency room before ketoacidosis
occurs and a possible coma.

References:

Diabetes Mellitus: A Guide to Patient Care by Lippincott Williams and Wilkins

Nutrition and Diagnosis-related Care by Sylvia Escott-Stump

Urinalysis and Other Body Fluids by Susan King Strasinger

Handbook of Disease by Lippincott Williams and Wilkins

Principles of Anatomy and Physiology by Gerard Tortora