Anna Garcia’s Horrible Life Will Birch

14 Months (3.1.2) Complaint: Anna is running a fever, is extremely lethargic, experiencing breathing problems, and also is in a lot of pain. Notes: Below 5th percentile on growth curve Weight is between 10 and 25th percentile Swelling in hands and feet Abdomen is tender and enlarged on left side Extremely irritable and fussy

14 Months (Continued) Tests Performed: CBC Hematocrit Blood Oxygen Reduced Red Blood count levels Increase WBC count Hematocrit Below Normal (20%) Blood Oxygen Lower than normal CT Scan Abnormal Spleen, Splenic Sequestration Sickle Cell Positive for Sickle Cell Anemia

14 Months (Continued) Treatment: Diagnosis: Sickle Cell Anemia Severe Anemia Splenic Sequestration Large collection of blood in spleen because of sickle cell shape. Treatment: - Hydration, Pain Medication, Red Blood Cell Transfusion, Antibiotics to prevent infections

14 Years (2.1.1) Complaint Physical Exam Anna has had fatigue and the inability to complete regular activities without rest. She also always feel thirsty and uses the bathroom quite frequently. Physical Exam All areas look very normal Found glucose in the urine

14 Years (Continued) Diagnosis: Type 1 diabetes. Glucose levels are high and she uses insulin to regulate her levels. She is dizzy because her low glucose levels don’t allow glucose to be used for energy She uses the restroom a lot because water is being pulled our of cells which creates more urine and the thirst quench

37 Years (4.2.1) Complaint: Anna has been having self resolved chest pain. She eats a high diet in both calories and fat. She consumes 3 glasses of wine after work and has not kept up with exercise. Takes daily aspirin. Has family history of early heart disease as well as uncontrolled hypertension.

37 Years (Continued) Physical Exam: Cardiac Test Results: Anna is a tachycardic, has occasional tingling in her right calf, blood pressure was 142/85 (high), and a slight heart murmur was detected. Cardiac Test Results: Blockage in the left anterior descending coronary artery

37 Years (4.3.1) Complaint: Analysis: Anna has been having self resolved chest pain. She eats a high diet in both calories and fat. She consumes 3 glasses of wine after work and has not kept up with exercise. Takes daily aspirin. Analysis: Total Cholesterol: 389 (Normal: 160) LDL:243 (Normal: 100) HDL:60 (Normal) Triglycerides: 145 (Normal) A1C Test: 7.1% (A little high)

37 Years (Continued) Recommendations: She should reduce her intake of saturated fats and trans fats. This would decrease the amount of fatty foods she intakes. Eating foods with good fats will help lower LDL and total cholesterol levels.

6.1.2 Possible Ways of How She Died Diabetes: Ketoacidosis: Kidney failure due to the overworking of Kidneys filtering glucose out of blood. Also overworking because of the stress of UTI infection and the high ketones in the urine. The infections that diabetes may cause due to the delayed reaction time to fight the infection often related to Diabetic Neuropathy. Sickle Cell Anemia: Blood clot in body which causes very high blood pressure. Also, her high cholesterol included makes blood pressure higher causing a heart attack and death. Blood clot in brain which causes a stroke and death. Lack of oxygen getting to the body which builds up overtime in the internal organs resulting in organ failure and death. Heart Disease: High cholesterol and hypertension causes a heart attack. Heart murmur and family history of heart problems backs up the evidence.

6.2.1 Cause of Death The result of Anna’s death was her overall complications with diabetes and the result of Ketoacidosis. While other things contributed to her death, the complications that diabetes caused with her body was the reason she died. Diabetes often causes the failure of kidneys. The waste material that the kidneys filter through the body that eventually becomes urine, is contaminated with a high level of glucose in diabetics. The glucose in the kidneys causes the kidneys to overwork and overtime causes the kidneys to fail. In the 6.1.2 autopsy report the blood glucose level was 280 mg/dL and the normal range is between 70-125. Obviously the level of glucose in the kidneys is way too high for the kidneys to handle which could have caused kidney failure and eventually death. The autopsy report mentioned a very high level of ketones in the urine which shows that Ketoacidosis was the cause of death. Also, the autopsy report mentioned that the level of protein in Anna’s urine was very high. Having protein in the body is good, but when the kidney’s have built up protein in the blood, those substances build up and become useless and toxic. These large build ups of proteins and other waste material also causes the kidneys to overwork and eventually fail causing death. While all the problems that Anna Garcia had, including heart disease, sickle cell, UTI, and Diabetes, Ketoacidosis led due to the death of Anna Garcia.

Symptoms During Death Ketoacidosis has symptoms that Anna Garcia experienced first hand. The medical history reports and autopsy reports noted that she had very high quench for thirst, but was always thirsty. This is a very common symptom. Also, frequent urination and high glucose and ketones in the urine are the most common symptoms of Ketoacidosis. Other symptoms that Anna experienced during her death were nausea and vomiting, tiredness, and a flushed skin tone. This would explain the vomit found at the scene of the crime the day she was found dead.

Ways to Prevent It Going to the doctor regularly to have your blood, blood pressure, urine, and organs tested for other complications of diabetes is recommended. Keeping blood sugar levels in range is the best way to make sure that kidney disease is prevented. This can be done by taking meds for diabetes (Anna did not take hers 3-4 days before her death) and also using your insulin injections regularly. Short Term: Taking medication Taking Insulin shots Healthy Diet (Low glucose diet) Long Term: Healthy Lifestyle (Exercise and Diet) Going to doctor and taking precautions Kidney Transplant