Question

Ms. X is a 52-year-old Hispanic female who presented to the ED with a 3- day history of vomiting. She has been unable to keep anything down and has not eaten or drank anything for 3 days. She denies any dyspnea, cough, abdominal pain, chest pain, or fevers. She reports that she was around a friend who was sick with the "stomach flu" 4 days ago Vitals: 99.4-130-20-100/60, O2 sat is 100% on Room air. She is oriented x3. Heart rate is regular, no murmur or gallop. Lungs are clear bilaterally Abdomen soft and nontender. No peritoneal signs. She has decreased skin turgor and dry mucous membranes Lab Sodium Potassium Creatinine BUN lonized Calcium WBC Hematocrit Hemoglobin Result 137 mEq/L 2.8 mEq/L 1.5 mg/dL 7 mg/dL 3.0 md/dL 16,000 42% 14 aldL 7.53 37 mEa/L 45 mmH HCO3 PCO2

1. The clinical scenario is most consistent with which acid base disorder? You may simply list your answer below using a bullet point format. This does not have to be in a complete sentence.
2. What data in the clinical scenario supports your diagnosis? You may simply list your answers below using a bullet point format. This does not have to be in a complete sentence.

3. What caused this person’s acid base disorder? You may simply list your answer below using a bullet point format. This does not have to be in a complete sentence.
4. Describe the key pathophysiologic concepts. To answer this question completely, you must answer all of the sub-questions below using complete sentences. Each sub-question may be answered in 1-6 sentences.
   1. How did the etiology you identified in question 3 cause this acid base imbalance?
   2. What two pathological processes explain this patient’s potassium imbalance?
   3. Explain the pathological process which caused the calcium imbalance that this patient is experiencing?
   4. How does the pulmonary system compensate for the acid base disorder which this patient is experiencing?
   5. Which medication class may cause this acid base disorder and how?
5. For what actual or potential complications related to the diagnosis in question 1 does she need to be monitored? You may simply list your answer(s) below using a bullet point format. This does not have to be in a complete sentence.

Answer 1

The clinical scenario is most consistent with metabolic alkalosis acid base disorder.. metabolic alkalosis due to protracted severe vomiting and loss of gastric acids, dehydration and depletion of extracellular fluid volume.

Data in the clinical scenario shows patient has skin turgor and dry mucous membrane( dehydration)..PH is more than 7.40 indicate metabolic alkalosis. Metabolic alkalosis due to increased HCo3 accumulation due to acid loss..

Pathophysiology:

- volume depletion ( loss of gastric acid and chloride due to vomiting).

- due to increased plasma bicarbonate concentration made more hydrogen ion loss in the urine or from the gastrointestinal tract due to severe vomiting..

- hydrogen ion more into the cells, bicarbonate salts contraction more in extracellular bicarbonate,it is called contraction alkalosis.

- Due to increased bicarbonate concentration reduce the filtration, made bicarbonate reabsorption or retention..it prevent the excretion of excess bicarbonate in the urine or gastrointestinal tract.

- there is deficit in chloride, potassium chloride, hydrochloric acid.

- A deficit of sodium chloride, increase the PHCo3 .

- there is deficit of HCL or KCL, increased the PHCo3 due to loss of acid from the extracellular fluid (ECF)

Etiology:

- blood pH was greater than 7.40..

- due to loss of acid from ECF, blood PH alkalemia and plasma bicarbonate concentration increased..

- increased Paco2 due to plasma HCo3 concentration..

- loss of sodium and potassium depletion make bicarbonate reabsorption..

- there is decreased renal bicarbonate excretion through the urine..

- hypokalemia and hypochloremia occurs and due to the presence of vomiting loss of bicarbonate in the blood which leads to metabolic alkalosis .