Question

Use the information above to help you answer the questions below based on the patient information. (each question is worth 1 point)

Mr. X is a 56-year-old male admitted to a hospital for shortness of breath and breathing difficulties. He is diagnosed with pneumonia. He has a history of congestive heart failure, osteoarthritis, hypertension, gout, and coronary artery disease.

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Height: 5'9"   Weight: 220 pounds

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Current labs	Normal values	Current Arterial BGs	Normal values
Na = 133 mEq/L	135-147 mEq/L	pH = 7.9	7.35-7.45
Cl = 103 mEq/L	95-107 mEq/L	pCO2 = 30 mmHg	35-45 mmHg
K = 4.1 mEq/L	3.5-5.2 mEq/L	pO2 = 96 mmHg	70-100 mmHg
Glucose = 207 mmol/L	Up to 140 mmol/L	HCO3 = 26 mEq/L	19-25 mEq/L
BUN = 25 mmol/L	7-20 mmol/L
Creatinine = 1.5 mmol/L	0.5-1.4 mmol/L
Albumin = 3.2 mmol/L	3.2-5 mmol/L
Cholesterol = 320 mmol/L	<200 mmol/L

1. What is the primary indication that Mr. X has an acid–base disorder?

	a.	mildly elevated creatinine
	b.	mildly low sodium
	c.	borderline low albumin
	d.	high blood pH
	e.	borderline high potassium

2. Mr. X is likely to have which acid–base disorder?

	a.	physical acidosis
	b.	respiratory acidosis
	c.	respiratory alkalosis
	d.	metabolic acidosis
	e.	metabolic alkalosis

3. What factor is contributing most to his acid–base disorder?

	a.	gout
	b.	high cholesterol
	c.	pneumonia/shortness of breath
	d.	osteoarthritis
	e.	hypertension

4. Which compensatory disorder could Mr. X develop?

	a.	metabolic alkalosis
	b.	metabolic acidosis
	c.	respiratory alkalosis
	d.	respiratory acidosis
	e.	physical acidosis

5. What treatment would be the most effective for his acid–base disorder?

	a.	treat pneumonia and lose weight
	b.	control blood pressure and reduce blood cholesterol
	c.	anti-inflammatories for osteoarthritis and lose weight
	d.	insulin therapy and control blood pressure
	e.	manage heart condition and reduce blood cholesterol

Answer 1

1. D. The high blood pH is a clear indicator of an acid base imbalance. pH is a sensitive indicator of even a minute amount of imbalance.
2. C Respiratory alkalosis as evidenced by high blood pH, low pCO2 and normal HCO3 levels.
3. C. Pneumonia is the primary cause of respiratory alkalosis in this patient. Hypoventilation leads to low CO2.
4. B. Metabolic acidosis to tackle respiratory alkalosis.
5. A. Pneumonia should be treated first here.