Case #2
1. What is the primary acid-base abnormality? Explain your logic.
Metabolic acidosis
pH is acidotic/acidosis
bicarbonate and CO2 are low/ Metabolic
2. What are the signs and symptoms of metabolic acidosis?
Kussmauls respiration
Lethargy
3. Calculate the anion gap?
142-(10 +105)=27 Δ Anion gap=27 – 12= 15 is excess
4. He has anion Gap metabolic acidosis. What are the anions in this case causing this gap?
Ketones and lactic acid
5. What is the hydrogen ion concentration?
24 x 22 = 52.8 nM/L 10
6. Is there a compensatory mechanism for metabolic acidosis?
Hyperventilation
7. What is the predicted compensatory response? Is his compensatory response adequate? If it is not adequate what would it mean?
(25-10) x 1.2 = 18; Expected Pco2 = 40-18 = 22 mmHg + 2 mmHgConsider if the CO2 response is not appropriate to pH
Obstructive lung disease
Hyporesponsive respiratory center
Muscle weakness/ fatigue
8. Is this a simple or mixed disorder? Explain your conclusion.
9. What clinical condition(s) is (are) responsible for the acid-base disturbance in this patient? What course of events do you expect to occur when a Diabetic stops taking Insulin?Simple
Diabetic ketoacidosis
Lack of Insulin leads to cascade of events:
- Ketogenesis and hyperglycemia
- Obligate urination (osmotic diuresis)
- dehydration.
- hypoperfusion
- inadequate oxygen delivery
- Lactic acidosis
9. What are the physiologic mechanisms responsible for the
generation of this disturbance?
Lipolysis resulting in the formation of ketoacids.
Net loss of K ... urination
Possible high plasma K
10. What are the other causes for anion gap metabolic acidosis?
Metabolic acidosis with increased anion gap can be seen in