Question

Daryl is an 18 year old male.

hursin... Review of technol... Chapter 20: Crisis. Test bank for Path... Read the following case study and answer each of the questions. Daryl is an 18-year-old male, who was diagnosed with type 1 diabetes 10 years ago. He is brought to the emergency department by his parents. Daryl seems anxious and confused. He is pale and hyperventilating. He has a racing heart rate and hypotension. Blood glucose measurements indicate a serum glucose of 350 mg/dL Daryl explains that he ate "some junk food" with friends and forgot to take his insulin. Arterial blood gases are as follows: pH 7.25 PaO2= 100 mm Hg PaCO2 = 22 mm Hg Serum values reveal hyperkalemia, reduced bicarbonato, and acetone. 1. What acid-base abnormality does Daryl display? 2. Why is Daryl's PCO, value lower than normal? 3. Why is Daryl hyperventilating? 4. Why is Daryl's serum bicarbonate reduced? 5. Why is Daryl experiencing hyperkalemia? 6. What is the significance of the presence of acetone in the serum sample? 7. What medical intervention may help Daryl's condition? 2016 Deva Advantage for Pathoph y FA Davis Company Rev Must 2016

Answer 1

1. Combined respiratory and metabolic acid-base disturbance (Respiratory alkalosis and Metabolic acidosis)

Arterial Blood Gas (ABG) normal values are;

• pH =7.35 to 7.45
• Paco2 = 35 to 45 mm Hg
• Ho3- =22 to 26 mEq/L

The disorders of acid-base balance are Acidosis and Alkalosis.If the blood has too much acid or too little base it is acidosis and if the blood has too much base or too little acid it is alkalosis. The causes can be respiratory or metabolic.

Respiratory acidosis leads to pH below 7.35 and a Pco2 above 45 mm Hg. Bicarbonate is normal. In Respiratory alkalosis,pH is above 7.45 and Paco2 below 35 mmHg. Bicarbonate is normal.

Metabolic acidosis causes bicarbonate level below 22 mEq/L and a pH below 7.35. Paco2 is normal.In Metabolic alkalosis bicarbonate level is above 26 mEq/L and a pH above 7.45. Paco2 is normal.

In Daryl's case,pH is 7.25 which shows alkalosis, and low Paco2 (22 mmHg)  shows it is related to Respiratory.He has reduced bicarbonate level too.So he has Combined respiratory and metabolic acid-base disturbance that is Respiratory alkalosis and Metabolic acidosis.

2. Due to Hyperventilation.

Paco2 shows the amount of carbondioxide in the blood.In Hyperventilation person will "blow off" more carbondioxide.

3.The body tries to regulate the blood acid levels by getting rid of carbondioxide in the expired air and leads to hyperventilation.It can be due to Diabetic Ketoacidosis,which is a complication of diabetes.

4.Due to hyperventilation. Bicarbonate is a form of carbondioxide,So decreaed serum CO2 leads to decreased bicarbonates in blood.

5.Daryl is Diabetic.Patients with diabetes have poor capacity of kidney to excrete potassium into urine.This leads to hyperkalemia.

6.Acetone in serum sample shows decreased carbondioxide in blood.

7. VENTILATORY SUPPORT to improve serum carbondioxide

DIALYSIS for acid-base balance.