Case #2 A 19-year-old female imbibed about 7 beers within a short period of time

Question

Case #2 A 19-year-old female imbibed about 7 beers within a short period of time. She began to fed weak, dizzy, nauseous, and complained of a pounding headache. One of her friends suggested that she take a few Advils. Within 30 minutes she fell asleep, and her friends assumed it was the effect of the alcohol. After two hours a friend keenly observed that her breathing was somewhat erratic and shallow. They are unable to wake her. They call an ambulance and she is transported to the local emergency department. While en route to the ER, a petit mal seizure is noted by the paramedics. In the ER, her blood pressure is 70/50 mmHg. Her AST and ALT are elevated (approximately 300%). Her ABG values are as follows: pH=7.1 PCO2=74 HCO3=27 Blood chemistry reveals a hematocrit of 49; creatinine is high-normal. EKG demonstrates mild arrhythmia with occasional APCs. What is the significance of the pH? Did she effectively pass out or innocently fall asleep? Explain her erratic breathing. From a purely nursing protocol what do you believe her prognosis to be? What is the presumptive diagnosis?

Explanation / Answer

1. Normal blood pH is between 7.35 and 7.45. It reduces when the blood becomes more acidic. Alcohol (beer) is acidic and hence causes ketoacidosis in the patient, which is the reason for the blood pH to drop to 7.1

2. Advil is an antihistamine, anticholinergic and also has ibuprofen. Advil is used in treatment of aches and pains, however, it is also used as a night time aid as it induces sleep. Hence, the patient did not pass out but fell asleep.

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