CASE DISCUSSION:ALKALOSIS

NOOR HAFIZAH BINTI HASSAN 2007287236

CASE 1

A 25 y/o man, with no known medical illness

presented with 2 days history of fever,

productive cough and worsening SOB.

On examination:• He is hot and flushed with a temperature of 39°C• Using accessory muscles of respiration• ↓ chest expansion Lt LZ • Dull percussion note• ↓ air entry with bronchial breathing and fine end- inspiratory crepitations at Lt LZ

Vital signs:• Pulse rate: 104/min• Respiratory rate: 28/min• BP: 118/70 mmHg• SpO2: 89 % under room air

• ABG:– pH 7.50– PCO2 3.74 kPa

– PO2 7.68 kPa

– HCO3 23.9 mmol/L

– BE -0.5 mmol/L

Laboratory results:

• BUSE:-Urea 4.3 mmol/L- Na 138 mmol/L- K 3.7 mmol/L- Creatinine 78 mmol/L

1) Describe his gas exchange.

2) Describe his acid-base status.

3) Should he receive supplemental O2?

4) Is pulse oximetry a suitable alternative to repeated ABG monitoring in this case?

1) Describe his gas exchange.Type 1 respiratory failure

2) Describe his acid-base status. Uncompensated respiratory alkalosis

3) Should he receive supplemental O2?Yes, to correct the hypoxaemia.

4) Is pulse oximetry a suitable alternative to repeated ABG monitoring in this case?- With moderate hypoxaemia and no ventilatory impairment, monitoring by pulse oximeter is more appropriate than repeated ABG sampling.- indications for further ABG?

CASE 2

A 35 y/o woman in a gynaecology ward develops

severe vomiting 1 day after EL BTL. She continues

to vomit continuously for a further 3 days.

Examination of her fluid balance chart reveals

that she is failing to keep up with her fluid losses

but has not been prescribed intravenous fluids.

On examination: - She appears dehydrated, with ↓ skin turgor and dry mucous membrane. Abdominal examination is normal.- Vital signs: PR: 100 beats/min BP: 160/100 mmHg RR: 10 breaths/min T: 36.6 °C

ABG:pH 7.44PCO2 6.4 kPa

PO2 11.1 kPa

HCO3 32 mmol/L

Base excess +4 mmol/l

Electrolyte:Na 133 mmol/LK 3.0 mmol/LCl 91 mmol/L

Laboratory results:

1) Describe her acid-base status. Compensated metabolic alkalosis

2) Explain the electrolyte abnormalities.- Vomiting causes loss of H+ in gastric juice. Normal response of the kidneys is to increase excretion of HCO3

to restore acid-base balance.- However, persistent vomiting also leads to fluid, Na, K, and Cl depletion. In this circumstance the overriding goal of the kidneys is salt & water retention.

3) Manage this patient.IV administration of fluid and electrolyte would allow kidneys to excrete more HCO3 , thus correcting the alkalosis