Case #2
The patient is a 55 year-old male with a history of diabetes. His wife states that he has become increasingly lethargic and fatigued over the past several days.
On physical exam the patient is a well-developed, obese male appearing older than his stated age. Blood pressure 160/98, pulse 76, respirations 20 and he was afebrile. HEENT exam was unremarkable. Cardiac exam demonstrated an S1, S2 without S3, S4 or murmur. Pulmonary auscultation and percussion were within normal limits. The abdomen was benign. Extremities were without abnormality.
Laboratory Data
|
Chemistry |
Normal Values | Arterial Blood Gas | |
| Sodium | 142 | 136-146 mmol/L | pH 7.30 PCO2 22 mmHg PO2 108 mmHg bicarbonate 10 mmol/L |
| Potassium | 4.4 | 3.5-5.3 mmol/L | |
| Chloride | 105 | 98-108 mmol/L | |
|
Total CO2 |
10 | 23-27 mmol/L | |
|
BUN |
22 | 7-22 mg/dl | |
| Creatinine | 1.5 | 0.7-1.5 mg/dl | |
| Glucose | 265 | 70-110 mg/dl | |
Questions
1. What is the primary acid-base abnormality? Explain your logic.
2. What are the signs and symptoms of metabolic acidosis?
3. Calculate the anion gap?
4. He has anion Gap metabolic acidosis. What is the hydrogen ion concentration?
5. Is there a compensatory mechanism for metabolic acidosis?
6. What is the predicted compensatory response? Is his compensatory response adequate? If it is not adequate what would it mean?
7. Is this a simple or mixed disorder? Explain your conclusion.
8. What clinical condition(s) is (are) responsible for the acid-base disturbance in this patient?
9. What are the physiologic mechanisms responsible for the generation of this disturbance?
10. What are the other causes for anion gap metabolic acidosis?