Mini Case study Acid Base Disturbance NURS 5150
The patient is a 55 year-old male with a PMH significant for diabetes, testicular ca (S/P radiation treatment 6 years ago), anxiety. His wife states that he has become increasingly lethargic and fatigued over the past several days. She denies that he has experienced CP, palpitations, SOB, PND, orthopnea.
On physical exam the patient is a well-developed, obese, ill appearing male, appearing older than his stated age. Blood pressure 160/98, pulse 76, respirations 20 , afebrile. HEENT exam was unremarkable. Cardiac exam demonstrated a regular S1, S2 without murmurs, rubs, or gallops. Pulmonary auscultation and percussion were within normal limits, no adventitious breath sounds. The abdomen was benign. Extremities were without abnormality. No edema present.
Laboratory Data
Chemistry
Normal Values
Arterial Blood Gas
Sodium
*** mmol/L
pH 7.30
PCO2 22 mmHg
PO2 108 mmHg
bicarbonate 10 mmol/L
Potassium
4.4
3.5-5.3 mmol/L
Chloride
*** mmol/L
Total CO*** mmol/L
BUN
22
7-22 mg/dl
Creatinine
1.5
0.7-1.5 mg/dl
Glucose
*** mg/dl
Questions
1. What is the primary acid-base abnormality?
2. What are the signs and symptoms of metabolic acidosis?
3. Calculate the anion gap?
4. What is the predicted compensatory response? Is his compensatory response adequate? If it is not adequate what would it mean?
5. What clinical condition(s) is (are) responsible for the acid-base disturbance in this patient? Explain.
**Use evidenced-based resources and site resources please APA format**
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Study Notes
The primary acid-base abnormality in this patient is metabolic acidosis.
Signs and symptoms of metabolic acidosis can include:
Lethargy and fatigue (as mentioned by the patient’s wife)
Rapid breathing (Kussmaul respirations)
Nausea and vomiting
Abdominal pain
Confusion or altered mental status
Increased heart rate
To calculate the anion gap, you need the values for sodium (Na+), chloride (Cl-), and bicarbonate (HCO3-). The formula for calculating the anion gap is:
Anion Gap = [Na+] – ([Cl-] + [HCO3-])
However, the values for sodium and chloride are not provided in the laboratory data, so the anion gap cannot be calculated.
In metabolic acidosis, the compensatory response is respiratory compensation, which involves the lungs attempting to decrease the concentration of carbon dioxide (CO2) in the blood. This is achieved by increasing the respiratory rate, known as compensatory hyperventilation.
To determine if the compensatory response is adequate, you would need the patient’s measured or expected PCO2 value. However, the PCO2 value is not provided in the laboratory data, so we cannot evaluate the adequacy of the compensatory response.
The clinical conditions responsible for the acid-base disturbance in this patient cannot be determined without additional information. However, based on the information provided, potential causes of metabolic acidosis in this patient with diabetes, a history of testicular cancer, and a significant increase in anion gap could include diabetic ketoacidosis (DKA) or lactic acidosis due to a malignancy.
It is important to note that a comprehensive Assessment of the patient’s medical history, physical examination, and additional laboratory tests would be necessary to make an accurate diagnosis and determine the underlying cause of the acid-base disturbance. A healthcare professional should be consulted for a proper assessment and management of the patient.
