Case Study A: Vomiting Mr. K.B. is age 81 and has had gastritis with severe vomi

Question

Case Study A: Vomiting

Mr. K.B. is age 81 and has had gastritis with severe vomiting for 3 days. He has a history of heart problems and is presently feeling dizzy and lethargic. His eyes appear sunken, his mouth is dry, he walks unsteadily, and he complains of muscle aching, particularly in the abdomen. He is thirsty but is unable to retain food or fluid. A neighbor has brought Mr. K.B. to the hospital, where examination shows that his blood pressure is low, and his pulse and respirations are rapid. Laboratory tests demonstrate elevated hematocrit, hypernatremia, decreased serum bicarbonate, serum pH 7.35, and urine of high specific gravity (highly concentrated).

This case study illustrates a combination of fluid, electrolyte, and acid-base imbalances. Specific laboratory values are not given so as to focus on the basic concepts. For clarity, this case study is discussed in three parts, the early stage, middle stage, and advanced stage of the imbalances. Further information about the specific problems involved is given in each part and is followed by a series of questions.

Part C: Day 3: Admission to the Hospital

After a prolonged period of vomiting, metabolic acidosis develops. This change results from a number of factors:

* Loss of bicarbonate ions in duodenal secretions

* Lack of nutrients leading to catabolism of stored fats and protein with production of excessive amounts of ketoacids

* Dehydration and decreased blood volume leading to decreased excretion of acids by the kidney

* Decreased blood volume leading to decreased tissue perfusion, less oxygen to cells, and increased anaerobic metabolism with increased lactic acid

* Increased muscle activity and stress leading to increased metabolic acid production

These factors lead to an increased amount of acids in the blood, which bind with bicarbonate buffer and result in decreased serum bicarbonate and decreased serum pH or metabolic acidosis.

1. List several reasons why Mr. K.B. is lethargic and weak.

2. Predict the serum level of carbon dioxide or carbonic acid in this case.

3. If Mr. K.B. continues to lose body fluid, why might serum pH decrease below 7.35?

4. If serum pH drops below 7.35, what signs would be observed in Mr. K.B.?

5. Describe the effect of acidosis on serum potassium levels.

6. Mr. K.B. will be given replacement fluid therapy. Why is it important that sodium and potassium be given as well as water?

Explanation / Answer

The following reasons are to tell the condition of the patient.

His hypernatremia and hematocrit condition- during this the body of the patient has low water amount. The hypernatremia condition reveals the high sodium level in blood that causes weakness, thirst, and nausea like symptoms. Maybe the patient was not taking enough water or maybe he was feeling thirsty from long time. These causes water loss in the body and kidneys perform form more water saving that causes concentrated urine or hypersthenuria condition (at high specific gravity). These things made the patient feeling dizzy and lethargic. However decreased serum bicarbonate condition comes through uses of aspirin, which heart patients generally use. This patient may have 6-10 mEq/L bicarbonate ions.

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