Question

Ms. Rose is an elderly woman with diabetes who has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time. Upon admission, her laboratory values show the following: Sodium (Na+) 156 Potassium (K+) 4 Chloride (Cl–) 115 Arterial blood gases (ABGs): pH 7.30; pCO2 40; pO2 70; HCO3– 20

a. What type of water and solute imbalance does Ms. Rose have?

b. What symptoms would you expect to find?

c. What would be the treatment?

d. What do her ABG results mean?

e. Does she have an anion gap?  

2. Mr. Appel has severe chronic obstructive pulmonary disease (COPD). He is admitted to the hospital with the complaint of increasing dyspnea, increased sputum, anxiety, and diaphoresis. He states he feels weak and tired. He routinely takes a diuretic (furosemide) and his pulmonary medications. The following laboratory values are obtained: Arterial blood gases: pH 7.25; pO2 60; pCO2 78; HCO3– 30 Sodium (Na+) 140 mEq/L Potassium (K+) 2.0 mEq/L Chloride (Cl–) 105 mEq/L

a. What type of imbalance does Mr. Rose have?

b. Interpret his ABGs.

Answer 1

1. a. hypertonic imbalance with a high-solute extracellular fluid (ECF) concentration.

Mrs. brown's extracellular fluid has perished, and the intracellular space fluid has now been carried into the extracellular space.

b. Polydypsia, fever, irritability, increased heart rate, hypotension, decreased weight, weak pulses, oliguria, altered cognitive function, seizures, and cerebral hemorrhage.

c. For hypernatremia, administer a salt-free, D5W so that the serum sodium level would be the normal and proper treatment of the underlying cause of volume depletion and management of hyperglycemia and acidosis.

d. Metabolic Acidosis ( pH 7.30; pCO2 40) and hypoxemia (pO2 70)

e. 156 +4 -(20) +115 = 25 mEq/L (Normal is10 to 12 mEq/L

So, she has a positive anion gap which means ACIDOSIS.