Acid Base - Medical Case Study

A 22-year-old woman reports having been sick with the flu for the past eight days. Some of the notable symptoms she is experiencing include: frequent vomiting and having difficulty keeping food or liquids down. Due to continuous vomiting, she has become severely dehydrated and it is also reported that she has been using more than the recommended dose of antacids in an attempt to calm nausea. A few days ago she fainted at her home and was taken to a local health facility where IV was placed to rehydrate her and also an arterial blood gas sample was drawn. She reported to the doctors that for the past eight days she had poor tolerance of fluids or other diet and frequent emesis. The results of the arterial blood gas sample were as follows: pH 7.5, PaCO2 40mm Hg, PaO2 95%, SaO2 97%, PaO2 95 mm Hg, and HCO3 32 meq/liter. However, for us to determine the deviations and the probable cause of illness, it is imperative that we compare these results with the normal test results for these components. For a normal person, pH should range between 7.35- 7.45, PaCO2 35-45 mmHg, SaO2 95-100%, HCO3 22-26 meq/liter, and PaO2 80-100mm Hg. From these two sets of results, we realized that there is a deviation in the pH and HCO3. This shows that the patient is in metabolic alkalosis. This is because her pH is high at 7.5 which is a sign of alkalosis. Her HCO3 is also high at 32meq/liter which further indicates that the condition is metabolic and not respiratory (Pruitt, 2004). I believe excessive use of antacids, dehydration, and vomiting several times a day are the major factors that contributed to this acid-imbalance. In this article, we will discuss the case study above to determine the implications of acid-base imbalance.

Arterial blood gas (ABG) sample obtained from the patient shows that the young lady has an uncompensated metabolic alkalosis. But first we should understand how respiratory and renal systems would attempt to compensate for this acid-base disturbance. We know that HCO3 often monitors the kidneys responsibility in the acid-base system. This means that for the renal system to compensate for the acid-base imbalance the kidneys will be forced to excrete excess HCO3 (McCance, 2014). As easy as it may seem this process takes several days to occur. Respiratory system, on the other hand, will use chemoreceptors in the respiratory center to consequently trigger hypoventilation which leads to increased compensatory respiratory acidosis. However, in this case, respiratory system has not attempted to compensate for the changes in the acid-base imbalance. Therefore, the cause of acid-base imbalances in this young lady is due to vomiting, dehydration, and overuse of antacids.

Metabolic alkalosis is often caused by vomiting and administration of antacids or sodium bicarbonate (Burcham, 2016). In this case, the patient has been using more than the recommended dose of antacids. Therefore this is likely to be the probable cause. To correct this acid-base imbalance, we will first start by restoring the fluid balance. However, for this patient, the metabolic alkalosis should be treated by intravenous infusion of sodium chloride with potassium chloride. This process will assist the kidneys to eliminate excess bicarbonate and consequently restore the acid-base balance to normal levels.

In conclusion, metabolic alkalosis often occurs as a result of increased bicarbonate concentrations or decreased hydrogen ion concentration. Focused assessment allows us to understand how the kidneys attempt to regulate the acid-base imbalances caused by increased bicarbonate concentrations. These assessments allow us to understand the individual roles played by both the renal and the respiratory systems in regulating the acid-base imbalances. Complete assessment, on the other hand, determines if the patient has access to a primary care physician and provides resources for accessing care. It involves educating the patient about the treatment and giving her expert advice on the consumption of antacids, when to seek medical care, and how to build tolerance of diet. Complete and focused assessments are similar in the sense results from a complete assessment is used to in the focused assessments.

References

Burcham, DNSc, FNP-BC, J., & Rosenthal, RN, DNP, ACNP-BC, L. D. (2016). Lehnes Pharmacology for Nursing Care (9th ed.). St. Louis, Missouri 63043: Elsevier.

McCance, K. L., & Huether, S. E. (2014). Pathophysiology: The Biologic Basis for Disease in Adults and Children (7th ed.). St. Louis, Missouri 63043: Elsevier.

Pruitt, RRT, CPFT, MBA, W. C., & Jacobs, RN, CCRN, CEN, MSN, M. (2004). Interpreting Arterial Blood Gases: Easy as ABC Nursing. Retrieved from http://ovidsp.tx.ovid.com.lopes.idm.oclc.org/sp-3.24.0a/ovidweb.cgi?