Case study: Fluid Electrolyte Disturbances

Mr. Apple is a 35-year-old men with type I insulin-dependent diabetes. He has had the flu for the past week. Mr. Apple is admitted to the hospital because of intractable nausea and vomiting. He presents with hypotension, dry mucous membranes, and poor skin turgor. The patient is tachypnic, and his breath has a fruity odor.
His laboratory data are as follow:
Na+ = 132 mEq/L
K+ = 6.0 mEq/L
Cl- = 90 mEq/L
HCO3- = 14 mEq/L
pH = 7.29,
PCO2 = 66 mm Hg,
PO2 = 62 mm Hg,
Glucose = 800 mg/dL
What acid base disturbances are present?
Does Mr. Apple have a normal anion gap?
What are the clinical symptoms and laboratory tests that indicate Mr. Apple’s volume status?
Why would you say Mr. Apple has hyperkalemia?
What would be the treatment?
2. This is an example of the assignment
Mr. Apple is experiencing acid-base disturbances. With a pH of 7.29 and his HCO3 14, this is evidence of metabolic acidosis. In response to this imbalance, additionally with a PCO2 of 66 shows evidence of acute respiratory acidosis. If this were a chronic condition, the renal buffer mechanism would have had time to initiate compensation and you would see a high HCO3 and normal pH. Mr. Apple’s tachypnea is the beginning of respiratory acidosis. His body is fighting to blow off CO2. Eventually, his breathing will become depressed responding to the build up of CO2. His fruity odor brings attention to his body’s attempt to get rid of built up acetone. If there were an acetone level reported, my hunch is that it would be positive with his fruity breath and glucose level of 600 indicating Mr. Apple is in diabetic ketoacidosis (DKA).
Mr. Apple presently has an anion gap of 32, which was figured by the sum of Cl- and HCO3 subtracted by the sum of Na+ and K+. This further supports the diagnosis of metabolic acidosis.
Clinically, Mr. Apple is exhibiting signs and symptoms of volume depletion by his report of intractable vomiting in addition to his hypotention, dry mucous membranes, and poor skin turgor. Mr. Apple’s laboratory tests support his clinical symptoms of volume depletion. His Na+ is decreased with a result of 132 (136-145 normal value). His intractable vomiting has caused a pure sodium deficit. Mr. Apple’s vomiting has also been significant enough to lower his Cl- value to 92 (96-106 normal value) which is an important electrolyte that helps regulate the body’s metabolic system.
Mr. Apple’s K+ level is 6 (3.5-4.5 normal value) which is indicative of hyperkalemia. This is to be expected with metabolic acidosis. In response to the excess acid, buffer systems attempt to regulate pH by moving H+ into the intracellular space and K+ will move out into the extracellular space. Additionally K+ is sent out of the cell with insulin deficiency and acidosis.
To treat Mr. Apple, isotonic fluid replacement should be initiated. This fluid choice is one that best matches intracellular fluid and has the equal osmotic pressure, which will prevent additional fluid shifting in and out of the cells. This will aid rehydration in attempt to bring his Na+ and Cl- back to normal as well as dilute his serum glucose level. His K+ level can be treated by administering glucose and insulin which will push K+ back into the cells. Additionally, Mr. Apple will require IV sodium bicarbonate to help correct the metabolic acidosis and further lower serum potassium.

3 Simple steps to get your paper done
Step 1	Step 2	Step 3
Place Order	Down to work	Paper is Ready!
Takes just a few minutes!	Best writer takes the order	Access via your account