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Discuss the magnitude of homone Response.?

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Please print out the case study and hand write your answers on the sheets. Emailed or typed case

 

studies will NOT be accepted. You may work in groups but you CANNOT turn in identical papers.

 


 

BIOL 2402

 

CASE STUDY 1

 

NAME _______________________________

 


 

GROUP _______________________________

 


 

PERIOD (SECTION) _____________________

 


 

Jamie Richards is a 20 year old junior in college. She is majoring in biology and hopes someday to be a

 

pediatrician. Beginning about a month ago, Jamie noticed that she was waking up once, sometimes

 

twice a night, by the need to go to the bathroom. More recently, she has noticed that she needs to go to

 

the bathroom during her school day much more frequently than before, sometimes as often as once

 

every hour.

 

At first, Jamie thought that her increased frequency of urination was due to all the coffee she drank, but

 

when she reduced her coffee consumption to one cup in the morning, she still needed to go to the

 

bathroom just as often. In addition, Jamie was buying bottled water by the case, and she found herself

 

never without a beverage in her hand or nearby. She also noticed that her urine seemed pale and

 

colorless.

 

When Jamie told her mother or her problem, her mother became very concerned and arranged for

 

Jamie to see the family physician. Her physician found no abnormalities on physical examination.

 

However, a blood chemistry profile revealed the following

 

Plasma sodium level 149 mEq/kg

 

Plasma osmolality 308 mOsm/kg

 

Fasting plasma glucose 85 mg/dl

 

Urine osmolality 200 mOsm/kg

 

Urine glucose: negative

 


 

1. What are the normals for the above? What does osmolality mean? How is it measured?

 

Plasma sodium level

 

Plasma osmolality

 

Fasting plasma glucose

 

Urine osmolality

 

Urine glucose level

 


 

An extensive history revealed that no other member of the family had ever displayed Jamie?s symptoms.

 

Jamie had no history of traumatic head injury and an MRI of her brain was normal. Because of the

 

increased diuresis diabetes was suspected.

 


 

2. Compare and contrast diabetes mellitus and diabetes insipidus. How does the mechanism by

 

which diuresis occurs with diabetes mellitus differ from that which occurs in diabetes insipidus

 

(specifically what causes the diuresis in each case)?

 


 

3. Discuss the two types of Diabetes mellitus (ie Type I and Type II). What is insulin? Where is it

 

produced? What is its chemical structure? How is its release regulated? Describe the

 

mechanism by which insulin normally regulates blood sugar in the body.

 


 

4. Discuss the two causes of Diabetes insipidus (ie neurogenic and nephrogenic). What is ADH?

 

Where is it produced? What is its chemical structure? How is its release regulated? Why is ADH

 

also known as Arginine Vasopressin? Describe the mechanism by which ADH normally regulates

 

urine volume and water conservation by the body.

 


 

5. Discuss the magnitude of hormone response. Include the 3 factors: 1) hormone level, 2)

 

receptor number and 3) hormone-receptor affinity. How can each of the above factors result in

 

a modified response of target tissues to the hormone?

 


 

Next, a glucose tolerance test was performed. On the day of the exam Jamie was told to refrain from

 

eating for 8 hours. Water was allowed but no other beverages. Jamie was scheduled for a 3 hour test.

 

Her weight was recorded at 122 lbs.

 

She was given a solution of concentrated glucose to drink. It contained 100 gram of glucose. Blood

 

samples were taken at the beginning of the test and hourly thereafter for 3 hours. The results were as

 

follows:

 


 

Initial blood glucose level: 80 mg/dL

 

1 hour: 160 mg/dL

 

2 hour: 120 mg/dL

 

3 hour: 95 mg/dL

 


 

A blood sample was also checked for A1C. The value was 5.4.

 


 

6. Discuss the above results. What levels would indicate diabetes mellitus? What is A1C? How is

 

it indicative of diabetes mellitus? Should multiple tests be performed? Do you think Jamie has

 

the disease? Why or why not?

 


 

Next, her doctor conducted a carefully monitored water deprivation test. The morning of the test Jamie

 

was weighed at the doctor?s office.

 

Her weight was recorded as 122 lbs.

 

Jamie was to remain at the doctors office for the duration of the test. She was put on fluid restriction.

 

A urine and plasma osmolality chart was started.

 

Hourly, the weight of the patient, and her urine and plasma osmolality were measured, and recorded on

 

the chart.

 

Nurses were instructed to terminate fluid restriction if:

 

Patient?s weight fell by > 5%

 

Plasma osmolality increased to > 300 mOsm/kg.

 

If urine osmolality increased by <30 mOsm/kg (in total) over three successive urine samples

 

patient would proceed to DDAVP test

 

DDAVP test should be terminated if urine osmolality rose to >750 mOsm/kg

 

Jamie?s results were as follows:

 


 

Time

 

Weight

 

8:00 122 lbs

 

9:00 121.5 lbs

 


 

Post

 

Dehydration

 

Osmolality

 

mOsm/Kg

 

Urine

 

osmolality

 


 

Plasma

 

osmolality

 


 

Urine

 


 

200

 

200

 


 

DDAVP

 

298 administered

 

815

 


 

Post DDAVP osmolality

 

(mOsm/kg)

 


 

plasma

 


 

urine

 


 

> 750

 


 

> 750

 


 

Diagnosis

 


 

urine

 


 

283-293

 


 

Plasma

 


 

287

 

290

 


 

200

 


 

10:00 120 lbs

 

11:00

 


 

Post-dehydration

 

osmolality (mOsm/kg)

 


 

Post DDAVP

 

Osmolality

 

mOsm/kg

 


 

normal

 


 

290

 


 

> 293

 


 

< 300

 


 

< 300

 


 

nephrogenic diabetes insipidus

 


 

> 293

 


 

< 300

 


 

> 750

 


 

cranial diabetes insipidus

 


 

< 293

 


 

300-750

 


 

< 750

 


 

chronic polydipsia

 


 

< 293

 


 

300-750

 


 

< 750

 


 

partial nephrogenic DI or primary polydipsia

 


 

> 293

 


 

300-750

 


 

> 750

 


 

partial cranial DI

 


 

7. What is DDAVP? What is the effect on the kidney? Discuss the monitoring of Jamie?s body

 

weight. Why was it important that her weight not be allowed to fall more than 5%? What acute

 

symptoms might she experience if it had?

 


 

7. Based upon the results above, and Jamie?s medical history, and the results of the MRI: Does

 

Jamie have Diabetes insipidus? If so?which type?

 


 

8. Write a short synopsis of the tests, the results, your diagnosis. What are your

 

recommendations to Jamie? Develop a treatment plan?

 


 

.

 


 

 


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