Anna s Death - Organizer by: Lindsay Markworth
Anna s Cause of Death Ketoacidosis leads to diabetic coma death cells don t get enough glucose due to lack of insulin body goes to stored fats for energy - produces ketones Ketones can poison body
14 Months At 14 months old, Anna was taken to the doctor due to severe pain and fever. Her heart was overworking, with a very high pulse at 175 bpm. She was urinating more than usual, and was very lethargic. Anna had swelling in the hands and feet, her abdomen was tender to touch, and was enlarged on the left side - possible sign of splenic sequestration. A CBC test was performed and showed low RBC count and a high WBC count. Her hematocrit saws lower than normal. Her blood was low in oxygen and a CT scan showed an abnormal spleen, which confirmed splenic sequestration. This led the doctor to perform a sickle cell test - Anna tested positive. Treatment - Intravenous hydration, pain meds, RBC transfusion, antibiotics to prevent infection
Age 14 Anna has no other medical problems except for sickle cell at this point. She goes to the doctor with complaints of fatigue and not being able to complete normal activities. She always feels thirsty no matter how much she drinks, and uses the bathroom more often. She has lost almost 10 pounds since last visit, despite the fact the diet and exercise hasn t changed. (exercise may have decreased due to fatigue) She has a family history of high cholesterol and heart disease. Anna wasn t experiencing any swelling or pain, and her speech, hearing and vision appeared normal. Her CBC test came back normal and her routine urinalysis showed glucose in the urine. Due to family history and glucose found in urine, Anna was sent in for glucose tolerance testing. GTT - Anna had a quick increases in glucose and it stayed high, which told us that she had diabetes. The level of insulin in Anna showed us that her body doesn t produce it. This told us that Anna had type 1 diabetes. Anna was fatigued because her cells were unable to get the energy they needed. The increased bathroom use and never satisfying thirst are symptoms of diabetes. Anna is also hyperglycemic because the cells are deprived of water due to the water leaving the cell.
Age 37 Anna went to the doctor because of two incidents of self-resolved chest pain. She eats a diet high in calories and fats and is overweight. She takes a daily aspirin and does Yoga once in a while, but hasn t kept up with daily exercise. Anna has a family history of early heart disease as well as uncontrolled hypertension. Her dad died of a heart attack at age 41. Anna s blood pressure and heart rate were high. Anna was evaluated by physical exam, cardiac stress test with EKG, and an echocardiogram. The physical exam showed that Anna is tachycardic, which means that her resting heart rate is between 90 and 105. A slight heart murmur was detected. The treadmill stress test showed that Anna experienced a drastic increase in BP as well as a few PVC s. Mitral regurgitation was noted, and the patient was only able to walk for 8 minutes before the test was concluded. These tests led to an angiogram to explore the cardiac vessels. Angiogram - revealed a blockage in the left anterior descending coronary artery. Angioplasty is recommended with the potential for stenting. Due to Anna s high systolic BP, she has stage 1 hypertension.
Age 37 A full cholesterol panel was conducted in the lab. Anna s total cholesterol was wayyyy to high at 389 mg/dl(normal - less than 200). Her LDL levels were also way to high at 243, and a normal level being less than 100. Her HDL levels and triglycerides were good. Her fasting blood sugar was normal, which meant she was keeping up with her diabetes and her hemoglobin A1c s were a bit high, but she has sickle cell, so it makes sense and it wasn t too high. A gel electrophoresis was performed to help determine who in her family had hypercholesterolemia. This helped the doctors fill in the pedigree of Anna s family and help diagnose her. Anna needs to take medication to help lower her cholesterol, and she also needs to start eating a healthier diet. If she doesn t do these things the plaque build up in her arteries could cause a blockage and heart attack or stroke.
Age 38 Anna was sent to the hospital for a sickle cell crisis. She was there for 5 days and had a catheter put in because she couldn't get out of bed due to the pain. Her BP and heart rate were very high and she gained more weight. She also had a temperature, which was most likely due to the sickle cell crisis. After she went home she noticed that she felt like she had to urinate all of the time but only a small amount would come out. The doctor sent a urine sample to the lab. The urinalysis tested positive for bacterial infection. The gross examination of colony morphology showed a medium sized, smooth, circular, convex, and red in color bacteria. The gram stain test showed a gram negative bacteria that was coccus shaped(round). The entertube system indicate that the type of bacteria present was Serratia marcescens. Treatment - Antibiotics and pain meds
Factors that contributed to Anna s Death Urinary - Certain illnesses can cause your body to produce higher levels of certain hormones. These hormones act against insulin. Urinary tract infections are common culprits. Immune - High fever can trigger ketoacidosis Nervous - Stress and Physical or emotional trauma: Anna was under stress with her family problems and having to deal with all of her diseases and their side affects. Cerebral Edema is a complication of ketoacidosis - swelling of the brain due to adjusting blood sugar level to quickly Cardiac - Heart disease (heart attack) can increase the risk of ketoacidosis, missed insulin doses can cause high glucose levels and increase the risk of ketoacidosis
Prevention Manage diabetes - Eat healthy and exercise everyday. Take insulin as directed by doctor. Monitor blood sugar level - Check three or four times a day: more if under stress or sick Adjust insulin dosage as needed - talk to doctor and make sure you account for all of the factors (diet, exercise, blood sugar level, sickness) Check Ketone level - Sick or under stress check urine for ketones: over the counter ketone test kit. If it is moderate or high contact doctor Act quickly if you suspect that you have diabetic ketoacidosis - seek emergency care.