Question

A 50yr old male with previously diagnosed gastric cancer was admitted to a hospital after 4 days of severe vomiting. His electrolyte levels are indicated below Na (meq/L) CI НСОЗ К BUN Cr Osm (mg/dL) (meq/L) (meq/L) (mg/dL) (meq/L) Normal 135-145 98-108 3.5-5.5 22-29 7-18 0.6-1.2 280-290 Patient 129 2.4 72 41 23 0.6 a. What are the electrolyte imbalance/s in the patient? b. Explain how the imbalances are interconnected to each other and correlate it to the patient's symptoms c. Explain the biological reasoning behind the electrolyte imbalances seen d. What is the metabolic acid/base status of this individual? Predict what the serum pH of this patient is likely to be. e. Do you have all the values to be able to accurately calculate the serum pH in this case? What would you need to make a more accurate calculation?

Answer 1

a, electrolyte imbalance caused by loss of body fluids due to severe vomiting, diarrhea, fever or sweating, for cancer patients this will happen due to treatment like chemotherapy. this patient having low sodium level(hyponatremia), low potassium level(hypokalemia), low chloride level(hypochloremia) and high bicarbonate level.
b, Electrolytes are sodium, magnesium, chloride, potassium, and calcium. when there is severe vomiting there will be severe water loss and electrolyte from the body. expelling gastric content leads to loss of chloride and hydrogen ions that cause hypochloremic metabolic alkalosis, a high level of HCO3 leads to increased PH level in the blood and there will be hypokalemia and elevated serum creatinine level due to high load of Hco3 that make the renal tubule to reabsorb it.
c, when there is high HCO3 due to severe vomiting there is electrolyte imbalance that increases the PH level. there is a low level of potassium and sodium and chloride due to metabolic alkalosis. due to low NaCl level Hco3 level increase and elevate Ions in the body.
d, Metabolic acid status for this patient includes high Hco3 level and low NaCl and PH level will increase, it indicates metabolic alkalosis.
e, All the values able to be calculated accurately the serum PH level. It was calculated by determination of Ph more than 7.45 and calculating the anion gap by elevated HCO3 level and degree of compensation and calculating excess anion gap >30mmol/l Hco3 it indicates metabolic alkalosis.