Case-1: Patient History A.C. is a 79-year-old man living in a long-term care fac
ID: 90216 • Letter: C
Question
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.
Case-1: Question-1
A.C. is prone to several acid-base and fluid-electrolyte disorders. Which of the following is/are true for this patient? (select all that apply)
Hypernatremia
Respiratory acidosis
Hypokalemia
Saline excess
Case-1: Question-2
How would A.C. attempt to compensate for respiratory acidosis should it occur?
Compensation through renal production of more bicarbonate ions.
Compensation through hypoventilation.
Compensation through hyperventilation.
Compensation through renal excretion of bicarbonate ions.
Case-1: Question-3
What acid-base imbalance might occur as a result of A.C.’s chronic diarrhea? (select all that apply)
Respiratory acidosis
Metabolic alkalosis
Respiratory alkalosis
Metabolic acidosis
Explanation / Answer
Q1, All the 4 options are correct. As all 4 are linked to electrolyte or pH imbalance.
Hypernatremia is a condition that occurs when the level of sodium in the blood is too low. In Hypokalemia serum potassium level of less than 3.5 mEq/L (3.5 mmol/L). Saline excess is seen as cardiac, hepatic or renal oedema,and general findings show increased exchangeable Na.Respiratory acidosis is a condition that occurs when the lungs can’t remove enough of the carbon dioxide (CO2) produced by the body. Excess CO2 causes the pH of blood and other bodily fluids to decrease, making them too acidic.
Q2. C and D .Hyperventilation is a condition in which you start to breathe very fast. The main cause of respiratory acidosis is that CO2 is not removed from the body. So, increasing the rate of breathing more CO2 will be removed from the body, and thus increasing the pH.
The bicarbonate ions, react with water and form carbonic acid which further decreaces the pH. Thus, production of HCO3- ions should be reduced.
Q3. D. Metabolic acidosis
Persistent diarrhea causes serious dehydration and acidosis. The kidneys release renin in response to the hypovolemia and the in-creased formation of angiotensin causes decreased renal blood flow and increased adrenal cortical elaboration of aldosterone. The consequent increased distal tubule Na+ reabsorption causes increased H+ and K+ secretion, with relatively more H+ than K+ secretion because of the acidosis.