Question

Mary is having a bad reaction to Topiramate. The doctor states he thinks she is having an unusual reaction to Topamax: inhibiting her renal carbonic anhydrase = metabolic acidosis. an IV will be given. Her blood levels are as follows: I. Which of the treatments below WOULD NOT help Mary's problem? CAN BE MULTIPLE- Breathing into a paper bag, an IV with pure bicarbonate (in normal saline), holding her breath for an extended period, an IV containing pure ammonia (in normal saline) II. The same type of acid-base disturbance occurs in all of the following circumstances. Which one is most analogous (most closely matches) Mary's condition? Uncontrolled diagetes mellitus, excess administration/ingestion of acidifying agent/drug, chronic diarrhea III. Although not the most effective treatment, excessive ingestion of baking soda would help Mary's problem. True/False IV. Mary's condition was exacerbated by hiking. True/False

Answer 1

Answer:

Mary is having a bad reaction to Topiramate. The doctor states he thinks she is having an unusual reaction to Topamax: inhibiting her renal carbonic anhydrase = metabolic acidosis. an IV will be given. Her blood levels are as follows:

Question- I. Which of the treatments below WOULD NOT help Mary's problem? CAN BE MULTIPLE-

Breathing into a paper bag, an IV with pure bicarbonate (in normal saline), holding her breath for an extended period, an IV containing pure ammonia (in normal saline)

Answer: holding her breath for an extended period

Question-2:. The same type of acid-base disturbance occurs in all of the following circumstances. Which one is most analogous (most closely matches) Mary's condition?

Uncontrolled diabetes mellitus, excess administration/ingestion of acidifying agent/drug, chronic diarrhea

Answer: excess administration/ingestion of acidifying agent/drug

Question-3: Although not the most effective treatment, excessive ingestion of baking soda would help Mary's problem. True/False ----> Answer: False

Question-4: Mary's condition was exacerbated by hiking. True/False -----> True

Reason:

Topiramate inhibiting carbonic anhydrase and leading to increased CO2 concentration and water on the blood followed by metabolic acidosis. Extended ingestion of baking soda would not help her.

1. Cells increase production of CO2 -----> CO2 reacts with H2O to produce H2CO3 -----------> H2CO3 releases H+ --------> Respiratory center is stimulated -----------> Rate and depth of breathing increase ---------> More CO2 is eliminated through lungs.

As a result of breathing into a bag, the partial pressure of CO2 in the alveolus increases, which decreases the pressure change between the tissues and the alveolus (because of saturation the rate of diffusion of gases decrease). As we exhale CO2. the partial pressure of CO2 in the alveolus increase because the CO2 is trapped in the breathing bag.