Case #3
The patient is a 28 year-old female who presents with a complaint of muscular weakness and fatigue. She has lost 30 pounds since her last office visit one year ago. She has no other complaints.
Medications- multivitamins
Allergies-none
On physical exam she is a cachectic female appearing fatigued. Blood pressure 100/76, pulse 88, respirations 16 and she was afebrile. HEENT exam was remarkable for an erythematous pharynx with scattered excoriations. The remainder of the exam was normal except for her marked weight loss.
Laboratory Data
|
Chemistry . |
Normal Values | Arterial Blood Gas | Urine | |
| Sodium | 136 | 136-146 mmol/L | pH 7.48 PCO2 48 mmHg PO2 80 mmHg bicarbonate 36 mmol/L |
pH 6.0 |
| Potassium | 2.8 | 3.5-5.3 mmol/L | ||
| Chloride | 85 | 98-108 mmol/L | ||
| Total CO2 | 36 | 23-27 mmol/L | ||
| BUN | 20 | 7-22 mg/dl | ||
| Creatinine | 1.0 | 0.7-1.5 mg/dl | ||
| Glucose | 80 | 70-110 mg/dl | ||
Questions
1. What is the primary acid-base abnormality? How did you arrive at that conclusion? Answer
2. Calculate the anion gap? Is it important to calculate anion gap in metabolic alkalosis? When should we calculate anion gap? Answer
3. What is the hydrogen ion concentration? Answer
4. How did he compensate for metabolic alkalosis? Answer
5. What is the predicted compensatory response? Answer
6. Is this a simple or mixed disorder? How did you come to that conclusion? Answer
7. What are the common causes for metabolic alkalosis? Answer
8. If the urine chloride is < 10 mmol/L, what are the diagnostic possibilities? Answer
9. If the urine chloride is > 10 mmol/L, what are the diagnostic possibilities? Answer10. What clinical condition(s) is (are) responsible for the acid-base disturbance in this patient? What addditional information would you seek? Answer
11. What are the physiologic mechanisms responsible for the generation of this disturbance? Answer