Part I – Blood Work “Chris. Michelle. You go on… I’ll catch up in a minute.” Mar

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Part I – Blood Work “Chris. Michelle. You go on… I’ll catch up in a minute.” Mary hid her fear as she struggled to catch her breath. She had been so excited to go hiking with her children. Chris and Michelle were both home on fall break, and Mary had been looking forward to the family time. But she felt like she was hyperventilating, and now her chest was starting to hurt. “What, we’ve fi nally outlasted you on the trails?” Chris joked as he looked over his shoulder. “Mom, are you ok? You look awful.” “Don’t panic, but I think I need to go to the hospital.” “Michelle! Go get the car!” Chris yelled ahead. “Please don’t panic—I just want to get it checked out.” “Michelle!” After what seemed like an eternity, they arrived at the hospital. As Chris and Michelle helped their mother into the waiting room, the ER attendant noticed them and ushered the family into a small room. Dr. Rosen promptly took Mary’s medical history and ordered an EKG, chest x-ray, blood tests, and urinalysis. Th e tests were completed in short order, and about an hour later, Dr. Rosen appeared in the exam room. “I have some good news, and a little bad news. Th e good news is…” “Dr. Rosen to the ER, Code Blue. Stat!” said the voice on the PA. “Sorry, that’s my cue. But don’t worry, you’ll be fi ne…once we get you off of the Topamax®. Th is might take a while, so I’m leaving your chart. I hope I’ll be back to review the test results with you, but it might be someone else,” said the doctor as the door swung shut. “Mom, isn’t Topamax your migraine medicine?” asked Michelle. “Yes. It was originally designed as an epilepsy treatment, but I take it to prevent those migraines that used to put me in bed all day. How could it be causing this?” Mary wondered out loud. Chris broke the tension, saying, “Th ese are your records, right? Let’s see what we can fi gure out.” He fl ipped open her chart. On the top of the pile were Mary’s blood test results:

Normal range

Mary’s results*

Hemoglobin (g/dL)

12.0–15.0

12.8

Hematocrit (%)

36–44

37.5

Creatine kinase cardiac isozyme

0–3.9%

1

Creatine kinase MM isozyme

96–100%

99

Creatinine

0.5–1.4

0.9

pH

7.35–7.45

7.31

pCO2

(mmHg)

38–52

18.1

pCO2

(mM)

20–27

9.5

pO2

(mmHg)

70–100

121.0

HCO

3

-

(mM)

19–25

8.9

Glucose (mg/dL)

90–140

112

8. Th e same type of acid-base disturbance occurs in all of the following circumstances. Which one is most analogous (most closely matches) Mary’s condition? Explain.

a. Uncontrolled diabetes mellitus

b. Excess administration or ingestion of an acidifying agent or drug

c. Chronic diarrhea

9. Which of the following treatments would you recommend to correct Mary’s problem? Explain what eff ect each treatment would have upon her blood pH.

a. Breathing in a paper bag

b. An IV containing pure HCO3- in an isotonic solution

c. Holding her breath for as long as she can

d. An IV containing pure ammonia in an isotonic solution

10. Propose a reason why Mary developed the symptoms of her acid-base disturbance while hiking which hadn’t been apparent in her normal daily routine.

Explanation / Answer

8. Ms.Mary is diagnosed with chronic metabolic acidosis.same condition occurs in

A.uncontrolled diabetes mellitus.

9. Ms.mary has experienced acid base imbalansi and her blood tests show that it's more acidic now,hence choice of treatment would be

B.an IV containing pure HCO3- in isotonic solution.

10. During physical exterior,lactic acid fermentation occurs in muscles and CO2 level in blood increases and pH decreases.due to carbonic anhydrase inhibition,which is an unusual reaction due to topamax intake, she was unable to counteract the pH shift.

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