A young male college student became ill and was experiencing bouts of vomiting f

Question

A young male college student became ill and was experiencing bouts of vomiting for almost 3 days straight. During those 3 days of vomiting this college student was unable to hold food down and was thirsty all of the time. At the end of the thirs day he went to a clinic and could barely walk or talk. His blood pressue was 90/60 mmHg, he had decreased skin turgor and his mucous membranes were dried out. The results of his blood test were as follows:

Arterial:

pH -7.56

HCO3 -38mEq/L

Pco2-45mmHg

Venous:

NA+ 137 mEq/L

Cl- 82mEq/L

K+ 2.8mEq/L

He was given IV fluids and Potassium. Overnight his fluid and electrolyte levels returned back to normal.

1. Which acid/base disorder was he experiencing?

2. Would his breathing rate increase or decrease?

3. He lost an even amount of water and eletrolytes, explain renin-angiotensin/aldosterone mechanism and how it contributed to his loss of potassium.

4. Why was it important that he was given fluid intravenously and potassium?

5. How does a skin turgor test show how dehydrated a person is and why his mucous memberanes were so dry

Explanation / Answer

This could be a condition of metabolic alkalosis which is caused by high Hco3 and pH. They are characterized by hypokalemia too.

Bicabonate comers from Co2 and therefor to neutralize the effect of alkalosis body will show the slow and hypoventilation.

In the kidneys prorenin is converted to renin and and then comes to plasma and carries out the conversion of angiotensinogen released by the liver to angiotensin I to angiotensin II. Angiotensin II is a potent vaso-active peptide that causes blood vessels to constrict, resulting in increased blood pressure. Angiotensin II also stimulates adrenal cortex to release aldosterone which causes the tubules of the kidneys to increase the reabsorption of sodium and water into the blood, while at the same time causing the excretion of potassium (to maintain electrochemical balance). Now if the renin–angiotensin–aldosterone system is abnormally active, blood pressure will be too high and potassium would be low due to excreation.

Due to metabolic acidosis there was loss of potasium and blood pH should not go more high IV was provided. this condition even leads to neural problam and so considered iomportant to manage soon.

Skin turgor test is used to assess fluid loss or dehydration. Here if we grasps the skin on the back of the hand, lower arm, or abdomen between two fingers so that it is tented up. The skin is held for a few seconds then released. The different results could be as follow if skin have normal turgor snaps it rapidly goes back to its normal position. Skin has decreased turgor remains elevated and returns quite slowly to its normal position and that is sign of decreased water or dehydration. This test is not specific but quite useful in prognosis

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