Get to know your patient!

I believe I have finally settled into my volunteering role, I feel more comfortable when I’m on the ward and I feel welcome in the team I work with.

More importantly, I feel like I have really developed my communication skills. Today I spoke with a patient for over an hour. She told me all her ups and downs in her life, all the amazing experiences she has encountered and what she learned from them. Unfortunately, her health hasn’t been on her side therefore she has had many encounters with a variety of doctors. She told me what makes a good doctor and what makes a great doctors, she also told me what makes a bad doctor!

She told me a good doctor will cure you or treat you, but a great doctor will stay in your corner when times get hard. She said a great doctor is a friend and someone who you can tell everything to.

She is right!

If a patient only tells you half the story you (as a doc) only receives  half of a patients history. When trying to diagnose a patient with half of the facts it can be unsafe and inefficient. But lets say you do diagnose the patient but it is time to treat them. There are several options. The most effective one to treat the condition may not be the most effective to treat the patient.

DKA

Diabetic ketoacidosis is a complication concerning diabetes.

It starts off with the lack of the hormone insulin been produced by the pancreas.¬† Insulin’s function is to act as a bridge which allows glucose to diffuse into the cell. The insulin will bind to the receptor and allow the glucose to go into the cell.

Now the glucose is in the cytoplasm it will undergo glycolysis and then it will enter into the matrix of the mitochondria where the kreb cycle will occur which produces ATP which is then hydrolysed to produce energy. This is the function of how glucose can be used for energy in the body in a normal person.

Now in diabetic ketoacidosis the pancreas cease to produce insulin and therefore the glucose will not be allowed to enter the cell. If there is no glucose entering the cell there is no energy been produced. However the cell still has fats that it can break down in the cell for cellular respiration in matrix of the mitochondria. This provides the body with energy however the products are also ketone bodies.

 

The ketone bodies can cause metabolic acidosis.  One ketone body is called acetone. When a patient is in DKA they may present with a fruity breath. This is due to the acetone in there blood.

Another interesting thing is that drinking alcohol can temporairy cause the pancreas to produce insulin and therefore cause the same process to occur. This is called Alcoholic ketoacidosis.

Sources:

https://www.msdmanuals.com/en-gb/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/alcoholic-ketoacidosis