A Case of Metabolic Alkalosis

In the particular case, the patient despite suffering from flu for the last eight days has been taking an overdose of antacids while trying to calm her nausea. Consequently, she became severely dehydrated. Based on the arterial blood gas test, she was identified to be having HCO3- that is more than 24mEq/L (Esbaugh et al., 2016). Indeed, her acid-base disturbance is classified as metabolic alkalosis, which is caused by the retention of HCO3- and acid loss (Berend, De Vries, & Gans, 2014). Moreover, the level of her HCO3- is 32 meq/liter in the blood gas (Kraut, & Nagami, 2013). It is evident that the patient retained bicarbonate in the blood gas because of using an overdose of antacids and yet she was vomiting.

            To assess the condition of the patient suffering from acid-based disturbance, there was the need to understand the patient’s history, for instance, the issue of having flu for the past eight days, vomiting and not retaining fluids and food, arterial blood gas tested, and basic knowledge of biochemistry and physiology (Esbaugh et al., 2016). Through common sense, knowing that the patient was taking an overdose of antacids, it would be clear that this is among the factors leading to this acid-base disturbance. The assessment of the partial pressure of arterial oxygen (Pao2) compared with ventilation and the identification of the alveolar-arterial difference will help in identifying if the patient has lung disease (Berend, De Vries, & Gans, 2014). The calculation of the test results would assist in identifying the magnitude of the error. Indeed, the physiological approach of assessment is relevant in this case because of the application of the carbonic acid-bicarbonate buffer system. In this approach, changes in partial pressure of PCO2 result in more changes in bicarbonate and the acid-base status. 

            The acid-base status was associated with acidosis and alkalosis, conditions affecting the respiratory and metabolic systems of the patient. Metabolic acidosis leads to the rise in the depth and rate of ventilation the moment the body tries to excrete acid or CO2 (Esbaugh et al., 2016). Metabolic alkalosis results in a reduction in the level and magnitude of ventilation when the patient’s body works on keeping acid or CO2.

For the provision of adequate patient care, there was the conduct of the arterial blood gas test, which helped in understanding her condition deeply (Kraut, & Nagami, 2013). There is also the assessment of how different systems such as renal and respiratory tend to influence the nature of acid-base disturbances. The healthcare provider also evaluates the patient’s behavior and physical appearance (Berend, De Vries, & Gans, 2014). There is also the evaluation of the factors that might be leading to the patient’s vomiting problem and the issue of not retaining fluids and food in the body.

The renal and respiratory systems would try to compensate for the patient’s acid-base disturbance. The two systems would focus on stabilizing the plasma HCO3. As the fetal pH increases, the patient’s lungs will assist by blowing off the collected carbon dioxide which is caused by kidney functionality (Esbaugh et al., 2016). The renal function will prevent the kidney from responding to the acid-base disturbances. The two systems will operate to oppose the major disturbances. The respiratory system will compensate the metabolic acid-base disturbances through changing the alveolar ventilation as it takes place to respond to the basic metabolic problems. It might take 24 hours for the respiratory mechanism to finish the compensation activities (Kraut, & Nagami, 2013). The process changes the H+ concentration and respiratory depth and rate (Berend, De Vries, & Gans, 2014). There is the increased blood H+ or acidic pH, as the CO2 if excreted and acid in the blood being reduced.

The renal compensation of the acid-base disturbances involved the kidney changing the production of acid and bases, as it focuses on responding to the main respiratory disturbances. For the compensation to have full impact, it can take three to five days. Kidney responds to the alterations of blood pH and reduces H+ as it retains HCO3- in the presence of academia and retains H+ and eliminates HCO3- in the presence of alkalemia (Berend, De Vries, & Gans, 2014). The respiratory acidosis tends to make the kidneys remove acid and store base while respiratory alkalosis would cause the excretion of the base by the kidney as it retains acid. In patients without renal failure, renal compensation if the most powerful approach of compensating the acid-base disturbances (Kraut, & Nagami, 2013).

Acid-base disarrangements would be the appropriate pharmacologic intervention that is commonly used to correct this kind of acid-base disturbance (Kraut, & Nagami, 2013). The pharmacological actions entail the identification of hydrochloric acid or the hydrochloric acid precursor, which would assist in the restoration of ventilation. It would also be necessary to administer alkali in the case of superimposed metabolic acidosis. Indeed, alkali therapy in diabetic ketoacidosis and lactic acidosis together with the administration of bicarbonate would help in correcting the patient’s acid-base disturbances (Esbaugh et al., 2016). The educational needs for this patient are about the necessary diet to take to prevent the acid-base disturbances, how to take the prescribed medicines, and effective ways of living a positive life, which would enhance her recovery.

In conclusion, the assessment practice of the patient would entail knowing the patient’s history concerning her problem, the conduct of arterial blood gas tests, and realization of her biochemistry and physiology. The physiological approach would be effective in controlling the acid-base disturbances. There should be renal and respiratory compensation for the balancing of acid-base disturbances.

References

Berend, K., De Vries, A. P., & Gans, R. O. (2014). Physiological approach to assessment of acid-base disturbances. New England Journal of Medicine, 371(15), 1434-1445.

Esbaugh, A. J., Ern, R., Nordi, W. M., & Johnson, A. S. (2016). Respiratory plasticity is insufficient to alleviate blood acid-base disturbances after acclimation to ocean acidification in the estuarine red drum, Sciaenops ocellatus. Journal of Comparative Physiology B, 186(1), 97-109.

Kraut, J. A., & Nagami, G. T. (2013). The serum anion gap in the evaluation of acid-base disorders: what are its limitations and can its effectiveness be improved?. Clinical Journal of the American Society of Nephrology, 8(11), 2018-2024.