A previously healthy, young adult had cardiopulmonary arrest during a football game and died. The nurse knows which explanation is the most likely cause of death?

Choice A reason: The client has hypoglycemia during the night and hyperglycemia in the morning is the best explanation because it is the definition of the Somogyi effect, which is a rebound phenomenon that occurs in some people with type 1 diabetes mellitus. Type 1 diabetes mellitus is a condition where the pancreas does not produce enough insulin, which is a hormone that helps the cells use glucose, which is a sugar that provides energy for the body. The Somogyi effect happens when the blood glucose level drops too low during the night, usually due to taking too much insulin or not eating enough carbohydrates before bedtime. This triggers the release of hormones, such as glucagon, epinephrine, and cortisol, that raise the blood glucose level by stimulating the liver to produce more glucose and by preventing the cells from using glucose. This results in a high blood glucose level in the morning, which is called hyperglycemia.

Choice B reason: The client has not taken the prescribed insulin dose prior to the evening meal is not the best explanation because it is a factor that can cause the opposite of the Somogyi effect, which is the dawn phenomenon. The dawn phenomenon is a condition where the blood glucose level rises in the early morning, usually due to the natural increase of hormones, such as growth hormone and cortisol, that occur during the night. These hormones reduce the effectiveness of insulin and increase the blood glucose level. The dawn phenomenon can be worsened by not taking enough insulin or by eating too many carbohydrates in the evening.

Choice C reason: The client will have an abnormal glycosylated hemoglobin (HbA1c) for the next two months is not the best explanation because it is a consequence, not a cause, of the Somogyi effect. Glycosylated hemoglobin (HbA1c) is a test that measures the average blood glucose level over the past two to three months, by showing how much glucose is attached to the hemoglobin, which is the protein that carries oxygen in the red blood cells. The Somogyi effect can cause the HbA1c level to be higher than expected, because it reflects the high blood glucose level in the morning, not the low blood glucose level during the night.

Choice D reason: The client will experience complications earlier than other clients with type 1 diabetes mellitus do is not the best explanation because it is a general statement, not a specific explanation, of the Somogyi effect. The Somogyi effect can increase the risk of complications, such as eye, kidney, nerve, and heart problems, because it causes fluctuations in the blood glucose level, which can damage the blood vessels and the organs. However, the Somogyi effect is not the only factor that can affect the development and progression of complications. Other factors, such as genetics, lifestyle, and comorbidities, can also play a role.

Choice A reason: Appendicitis and peritonitis are not the most common cause of small bowel obstruction in adults because they are conditions that affect the appendix and the peritoneum, which are parts of the large intestine, not the small intestine. The appendix is a small pouch that is attached to the cecum, which is the first part of the large intestine. The peritoneum is a membrane that covers the abdominal organs and the abdominal wall. Appendicitis is a condition where the appendix becomes inflamed, causing symptoms such as pain, fever, or nausea. Peritonitis is a condition where the peritoneum becomes inflamed, usually due to an infection or a perforation of the abdominal organs, causing symptoms such as pain, fever, or shock.

Choice B reason: Sigmoid colon cancer is not the most common cause of small bowel obstruction in adults because it is a condition that affects the sigmoid colon, which is the last part of the large intestine, not the small intestine. The sigmoid colon is a curved segment that connects the descending colon to the rectum, which is the final part of the digestive tract. Sigmoid colon cancer is a type of cancer that develops from the cells that line the inner wall of the sigmoid colon, causing symptoms such as bleeding, change in bowel habits, or weight loss.

Choice C reason: Cirrhosis and ascites are not the most common cause of small bowel obstruction in adults because they are conditions that affect the liver and the abdomen, not the small intestine. The liver is a large organ that performs various functions, such as detoxifying the blood, producing bile, and metabolizing nutrients. The abdomen is the cavity that contains the digestive organs, such as the stomach, the small intestine, and the large intestine. Cirrhosis is a condition where the liver becomes scarred and damaged, usually due to chronic alcohol abuse, viral hepatitis, or fatty liver disease, causing symptoms such as jaundice, fatigue, or bleeding. Ascites is a condition where fluid accumulates in the abdomen, usually due to portal hypertension, which is a high blood pressure in the vein that carries blood from the digestive organs to the liver. Portal hypertension can be a complication of cirrhosis, and can cause symptoms such as abdominal distension, shortness of breath, or infection.

Choice D reason: Adhesions of the small intestine are the most common cause of small bowel obstruction in adults because they are bands of scar tissue that form between the loops of the small intestine, which is the part of the digestive tract that extends from the stomach to the large intestine, and is responsible for digesting and absorbing nutrients. Adhesions of the small intestine can block or twist the passage of food and fluid, causing symptoms such as pain, vomiting, or constipation. Adhesions of the small intestine can be caused by various factors, such as surgery, infection, or inflammation.