Case Study Of Acid-base Balance And Electrolytes
From the laboratory values given, the sodium level is increased at 147mEq/L. The normal values of potassium range from 135-144mEq/L. Elevated levels of sodium denote a condition called hypernatremia. The pH of blood is reduced to 7.33. The normal values range from 7.35 to 7.45. Blood pH levels below the lower limit of the normal values indicate acidosis, as in this patient’s case. The PCO2 is also elevated at 48. The normal values range from 35-45mmHg. An elevated PCO2 is a diagnostic finding of hypercapnia. This means that the patient doesn’t have an adequate exchange of air and is retaining CO2. The normal values for urine-specific gravity are 1.016 – 1.022. The values obtained from this patient indicate that she has an elevated urine specific gravity at 1.040. This is a sign of more solute in urine, which may result from dehydration (McCance & Huether, 2019)Case Study Of Acid-base Balance And Electrolytes. All other laboratory values are within the normal range.
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The only electrolyte imbalance the patient has is Hypernatremia. It is a hyperosmolar state due to a decrease in the amount of water in the body relative to sodium content. It is common in elderly patients with restricted water access or increased fluid loss (Wörnle,2021). The clinical manifestations that may be expected include confusion, lethargy, abnormal speech, irritability, seizures, abnormal jerks, and general cognitive dysfunction. This is due to effects on the nervous system, which results in neuronal shrinkage. Hypernatremia is also characterized by dehydration, and the patient may have symptoms that are synonymous with volume depletion. Symptoms of volume depletion include orthostatic hypotension, oliguria, dry skin, dry mucosal surfaces such as the oral mucosa, abnormal skin turgor, and tachycardia. Generalized weakness is also another clinical symptom that may be seen in the patient (Wörnle,2021)Case Study Of Acid-base Balance And Electrolytes.
Potassium levels are considered elevated if the values are above 5.0mEq/L in adults. This condition is referred to as hyperkalemia. The clinical manifestations of hyperkalemia vary according to the concentration levels of potassium. Levels higher than 7 mEq/L can present with neurologic and hemodynamic complications. Levels above 8.5 mEq/L can be fatal as it can cause cardiac arrest or respiratory paralysis (Palmer & Clegg, 2017). Symptoms of hyperkalemia are usually nonspecific. The most common symptoms are weakness and fatigue. Symptoms are usually related to muscular and cardiac dysfunction. Patients will present with dyspnea, palpitations, chest pain, and muscle paralysis. Examination of the patient may reveal bradycardia which may be due to heart block. The patient may also have a faster respiratory rate due to weakness of the respiratory muscles. An ECG is vital in monitoring patients with hyperkalemia. An ECG may reveal arrhythmias. The T-wave may also be peaked with a narrow base. Another ECG finding is the shortening of the QT interval and depression of the ST segment. Other ECG findings include small or absent P wave, wide QRS, prolonged PR interval, and augmented R wave (Palmer & Clegg, 2017)Case Study Of Acid-base Balance And Electrolytes. The fluid status of the patient should also be monitored. This includes tracking both the input and output. The electrolyte levels should be monitored regularly to assess for worsening of hyperkalemia. Excess electrolytes are excreted via the kidney. Monitoring kidney function is therefore vital. Arterial and venous blood gas should also be monitored for signs of acidosis.
The blood gas abnormality seen in this patient is respiratory acidosis. Respiratory acidosis results from alveolar hypoventilation, which causes an acid-base balance disturbance. CO2 is produced, and because of poor ventilation, most of it is retained in the body. This results in an increase in PCO2, i.e., hypercapnia. The normal range for PCO2 is 35-45 mmHg. An increased PCO2 lowers the ratio of bicarbonate (HCO3–) to PCO2. The net effect is a reduction in pH hence acidosis (Seiler et al., 2019)Case Study Of Acid-base Balance And Electrolytes. The pH level of this patient is 7.33. This falls below the normal range for pH, which is 7.35-7.45. The etiology of respiratory acidosis is multifactorial, ranging from CNS depression which causes hypoventilation, to lung diseases such as COPD, pulmonary edema, and pneumonia. Other factors include obesity, obstructive sleep apnea, hypermetabolic states such as thyroid crisis and sepsis. Treatment of respiratory acidosis in this patient includes improving ventilation.
The pH of blood measures the level of acidity or alkalinity. The normal pH ranges from 7.35 to 7.45. This pH is maintained at this level by a number of systems that kick in to compensate for any imbalances. These systems include the renal system, the respiratory system, and the cellular ion exchange system. The following equation governs the regulation of body pH: CO2 + H2OÛ H2CO3 Û H+ + HCO3 (McCance & Huether, 2019). An imbalance in any of the equation parameters prompts the systems to kick in. The respiratory system controls CO2 levels in the body. A decrease in pH triggers hyperventilation, leading to the expulsion of more CO2 and thus a reduction in H+ formation. This increases the blood pH back to normal. This mechanism acts inversely when the pH is high. Response from the respiratory mechanism is almost immediate to pH changes. The renal system responds to changes in the H+ levels. More H+ reduces the Ph of blood. This prompts the kidney to excrete more H+ in urine to restore the pH balance. HCO3, on the other hand, is reabsorbed by the kidneys to increase the pH of the blood. Response from the renal mechanism is slow and may take days to kick in. The cellular ion-exchange mechanism acts by exchanging H+ with another positively charged ion such as K+. This reduces the amount of H+ in blood. This system may cause hyperkalemia or hypokalemia (McCance & Huether, 2019)Case Study Of Acid-base Balance And Electrolytes.
References
Chong, W. H., Saha, B. K., & Medarov, B. I. (2021). Comparing Central Venous Blood Gas to Arterial Blood Gas and Determining Its Utility in Critically Ill Patients: Narrative Review. Anesthesia and Analgesia, 133(2), 374–378. https://doi.org/10.1213/ANE.0000000000005501
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: the biologic basis for disease in adults and children. St. Louis, MO: Elsevier Inc
Palmer, B. F., & Clegg, D. J. (2017). Diagnosis and treatment of hyperkalemia. Cleveland Clinic Journal of Medicine, 84(12), 934–942. https://doi.org/10.3949/ccjm.84a.17056
Seiler, F., Trudzinski, F. C., Kredel, M., Lotz, C., Lepper, P. M., & Muellenbach, R. M. (2019). Update: akute hyperkapnische respiratorische Insuffizienz [Update: acute hypercapnic respiratory failure]. Medizinische Klinik, Intensivmedizin und Notfallmedizin, 114(3), 234–239. https://doi.org/10.1007/s00063-017-0318-5
Wörnle M. (2021). Hypernatriämie [Hypernatremia]. MMW Fortschritte der Medizin, 163(20), 56–57. https://doi.org/10.1007/s15006-021-0457-8 Case Study Of Acid-base Balance And Electrolytes
