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
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