Question

Your diabetic patient's spouse has called you in to the room. You find your patient lethargic, warm and flushed. She is tachypneic with deep respirations and is tachycardic. A blood gas is drawn and her pH is 7.2 with an HCO3 level of 14 mEq/L. Consider her condition in terms of acid-base balance, including compensatory mechanisms and predict what orders would you anticipate that will correct the abnormalities in her acid-base balance.

Answer 1

The patients seems to have metabolic acidosis (decreased pH and decreased HCo₃ )

The compensatory mechanism happens in the following way

• Buffering:also called as HCO3 buffer system.The important function of it is to balance carbonic acid, bicarbonate and carbondioxide.Here CO2 and H2O reacts with each other and gives out a weak acid (carbonic acid )and a base (bicarbonate )along with a hydrogen ion.This acid and base helps to flush out any excess content and thus balancing.so called pH. Abnormality in this causes acid base imbalance
• The hydrogen ions are absorbed by protein,phosphates and carbonate as intracellular buffering.When this doesn't happen ,it causes acid base imbalance
• Hypetventilation happens in respiratory compensation
• Kidney compensation

The following orders are necessary to correct the balance

• Bicarbonate ir bicarbonate therapy :HCO3 infusion to increase the bicarbonate level (base)
• IV fluids to hydrate the patient
• Oxygenation to ensure more oxygen and remove carbondioxide (now carbondioxide mixes with water to form base ,carbonic acid)This acid and base acts together to maintain pH .
• Blood glucose monitoring and control with insulin to prevent diabetic ketoacidosis