Understanding Acid-Base Balance: A Case Study Analysis

Kathleen Britten

9/21/2016

Acid-Base Case Study (15 questions)

Case 1.

23 y/o female is post-op day two following a small bowel resection. Her nasogastric (NG) tube is connected to low intermittent wall suction and draining copious amounts of green fluid. Urine output has decreased to 0.3mL/kg/hr despite receiving IV fluids. Labs are as follows: pH 7.52 - base

PO2 90

Na 144

PCO2 48 - high

K 3.2

HCO3 39 - high

Cl 94

1) What does the elevated pH indicate? Metabolic Alkalosis

2) Is the primary process metabolic or respiratory? Why? Metabolic increased pH due to excess of HCO3.

3) Calculate the anion gap? Is the gap normal or abnormal? 14.2 high and abnormal

4) Is there compensation occurring? Full or partial? Partial compensation because

Mixed disorder – This is what we can call a mixed disorder because the patient has low HCO3 level due to metabolic acidosis and high PCO2 level due to the patient’s asthma.

2) Is the primary process metabolic or respiratory? Why? Diarrhea is causing an excess loss of bicarbonate/HCO3. When the basic molecule, bicarb, is lost, an acidic environment is created.

3) Calculate the anion gap? Is the gap normal or abnormal? 13.1 abnormal

4) Is there compensation occurring? Compensation is not occurring. Both values indicate acidity because there is too much CO2 and there is also too little HCO3. In regards to respiratory compensation, his breathing is impaired from asthma. Because the respiratory response to changes in HCO3 occurs much faster than metabolically, there is only one predicted compensatory response for primary metabolic acid-base disorders. Renal compensation, however, takes several days to occur, and would require an increase in HCO3.

5) What is the likely cause of this acid base disturbance? Breathing with asthma is indicative of poor oxygen and CO2 exchange. Diarrhea, loss of bicarb, can result in low bicarbonate levels and metabolic