Discussion: Fluid Balance
Discussion: Fluid Balance
A 75-year-old man was admitted with shortness of breath and lower extremity edema. He has been unwell for about a week and had multiple bouts of diarrhea over the previous 5 days. He does not take any medications. He was hyperventilating and was very distressed when EMS arrived. Admission arterial blood gas is listed below. He was on high concentration oxygen by mask on arrival to the emergency department.
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Chemistry Results
Na+ = 127
HCO3- 20
HCO- = 30meq/L 3
K+ = 5.2
BUN 50.5
Glucose 9.5 mmols/l
Cl- 79
Creatinine 0.38
Anion gap 33 mmols/l
Arterial Blood Gases
pH 7.58
pCO2 21 mmHg
pO2 154 mmHg
HCO3 19 mmol/l
Questions
Answer the Following Questions:
What is this patient’s acid-base disorder?
Discuss why you how you came to that conclusion.
Is the patient compensating?
What are the pathophysiological responses that the body is attempting to use to compensate?
A Sample Of This Assignment Written By One Of Our Top-rated Writers
Fluid Balance
The patient in the case study has Respiratory alkalosis based on a carbonic acid deficit of pCO2 below 35 mm Hg. In diagnosing the acid-base imbalance, I first noted whether the pH is low, acidosis, or high, alkalosis. In this case, the patient had a high pH indicating Alkalosis (Brauner, 2020). In the second step, I looked for which value, pCO2 or HCO3, was outside the normal range and could be the cause of the problem. If the cause is a change in pCO2, the problem is respiratory, and if it is HCO3, the problem is metabolic. The patient’s pCO2 was at 21 mm Hg, which is below the normal range of 35-45, indicating Respiratory Alkalosis (Brauner, 2020). On the other hand, the HCO3 level was at 19mEq/L, which is below the normal range of 22-26, indicating metabolic acidosis. In the next step, I looked at the value that does not correspond to the observed pH change, which was HCO3. This led to a conclusion of Respiratory Alkalosis since it corresponds to the pH change. Furthermore, the patient was hyperventilating, which is the primary cause of respiratory alkalosis.
The patient has respiratory alkalosis with partial compensation as evidenced by a drop in bicarbonate level. Bicarbonate levels outside the normal range show that the body is partially compensating for respiratory alkalosis by excreting bicarbonate ions (Hamilton et al., 2017). The patient’s body is attempting to compensate for the low PCO2 levels through kidney excretion. The kidneys can eliminate large amounts of acid and excrete base. They can also conserve and produce bicarbonate ions (Hamilton et al., 2017). The patient’s body is compensating for the low PCO2 and high pH levels by conserving hydrogen ions to and excreting bicarbonate to lower alkaline levels. The kidneys are the most effective regulator of pH. If they fail, the pH balance fails.
References
Brauner, C. J. (2020). Acid-base balance. Fish larval physiology, 185-198.
Hamilton, P. K., Morgan, N. A., Connolly, G. M., & Maxwell, A. P. (2017). Understanding Acid-Base Disorders. The Ulster medical journal, 86(3), 161–166.
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