Case-1: Patient History

A.C. is a 79-year-old man living in a long-term care facility. He has had multiple medical diagnoses, including heart failure (HF), chronic obstructive pulmonary disease (COPD), and a stroke. He is bedridden and receiving enteral tube feedings. He has chronic diarrhea thought to be related to his tube feedings. He receives digoxin and furosemide (Lasix) to manage his heart failure. Analyze this case study and answer the next three questions that follow.

Question 1- A.C. is prone to several acid-base and fluid-electrolyte disorders. Which of the following is/are true for this patient?

Hypernatremia

Hypokalemia

Respiratory acidosis

Saline excess

Question 2- How would A.C. attempt to compensate for respiratory acidosis should it occur?

Compensation through hyperventilation.

Compensation through renal production of more bicarbonate ions.

Compensation through hypoventilation.

Compensation through renal excretion of bicarbonate ions.

Question 3- What acid-base imbalance might occur as a result of A.C.'s chronic diarrhea?

Metabolic acidosis

Metabolic alkalosis

Respiratory alkalosis

Respiratory acidosis

Case-2: Patient History

L.S. is brought to the emergency department for management of acute mushroom poisoning. Her respirations are slow and shallow, and she is nonresponsive. She is admitted to the critical care unit to be closely monitored for the development of respiratory failure and renal failure, which often accompany mushroom poisoning. Her urine output is decreased to about 20 ml/hr. Her laboratory values are serum K⁺ = 5.7 mEq/L; arterial blood gases (ABGs): pH = 7.13, PaCO2 = 56 mm Hg, PaO₂ = 89 mm Hg, HCO₃- = 18 mEq/L.

Analyze this case study and answer the next four questions that follow.

Question 1- What is the most likely cause of L.S.'s potassium imbalance?

The most likely cause of L.S.'s potassium imbalance is renal failure.

The most likely cause of L.S.'s potassium imbalance is impaired kidney function.

The most likely cause of L.S.'s potassium imbalance is respiratory failure.

The most likely cause of L.S.'s potassium imbalance is her shallow breathing.

Question 2 - What is the relationship between acid-base balance and serum potassium level?

Alkalosis contributes to hyperkalemia.

Acidosis contributes to hyperkalemia.

Alkalosis contributes to hypokalemia.

Acidosis contributes to hypokalemia.

Question 3 - Categorize and explain the probable cause of L.S.'s acid-base disorder.

L.S. has respiratory alkalosis.

L.S. has respiratory acidosis.

L.S. has metabolic alkalosis.

L.S. has metabolic acidosis.

Question 4 - Can L.S. compensate for her acid-base disorder? (select all that apply)

She can compensate by hypoventilation.

She can compensate by hyperventilation.

She will not be able to compensate on her own because the lungs and the kidneys are malfunctioning.

She can compensate by excreting more bicarbonate ions.

Case-3: Patient History

T.J. is a 46-year-old science professor brought to urgent care this afternoon by his wife. T.J. has been at home for 3 days with severe diarrhea and vomiting. His youngest daughter was hospitalized earlier in the week with similar symptoms. T.J. has no significant medical history and takes no medications. Examination reveals an ill-appearing, pale, diaphoretic man who is having difficulty concentrating and answering questions. He has diffuse abdominal pain. Vital signs are as follows: Lying-HR 100, BP 100/80, resp 26, temp 100. Sitting-HR 136, BP 90/60. He has not urinated since yesterday morning.

Analyze this case study and answer the next three questions that follow.

Question 1 - What other laboratory or clinical data would be helpful in assessing T.J.'s fluid-electrolyte and acidbase status?

Blood test to assess the level of glucose.

Further assessment could include inspection of mucous membranes for dryness, skin turgor, status of neck veins, and presence of dizziness with position change.

Assessment of body temperature.

A chemistry panel would be helpful in assessing for imbalances of serum sodium, potassium, and bicarbonate.

Question 2 - Which assessment data should be monitored during fluid replacement therapy to determine when adequate volume has been restored?

Mental status should be assessed and expected to improve with adequate fluid replacement.

Vital signs should be monitored for resolution of tachycardia and postural symptoms, as well as intake and output.

Electrolytes should be monitored for resolution of any electrolyte imbalance.

Skin turgor and mucous membranes should be monitored for improvement of dehydration.

Question 3 - How might persistent vomiting and diarrhea alter acid-base balance?

Vomiting may contribute to metabolic alkalosis.

Metabolic alkalosis may occur as a result of persistent diarrhea.

Metabolic acidosis may occur as a result of persistent diarrhea.

Vomiting may contribute to metabolic acidosis.