mountain climber patient: the acid-base disturbance is metabolic acidosis. The d
ID: 78465 • Letter: M
Question
mountain climber patient: the acid-base disturbance is metabolic acidosis. The diagnosis for the patient is pulmonary edema. My question is how does pulmonary edema lead to acid-base disturbance? Be specific as you can about the source of the pH disturbance. ( I know that there is decrease in O2 and lead to build up of latice acid, but I can't really further explain)
Recovering alcoholic patient: the acid-base disturbance is metabolic alkalosis. The diagnosis for the patient is disulfarim (antabuse) complications. How is her diagnosis lead to acid-base disturbance? be specific about the source of pH disturbance.
Explanation / Answer
Part 1) When a patient suffers from pulmonary edema formation, the gaseous exchange across the alvelolar bed is deteriorated. The oxygen diffusion from the lungs to the blood is decreased and the person suffers from hypoxia. This causes a decline in pO2 in the blood and consequent increase in pCO2 in the blood. Since CO2 forms weak acid i.e. carbonic acid in the blood, the equilibrium reaction gets shifted towards more alkaline side of the reaction leading to increase in overall pH of the blood. Thus, carbonic acid mediated general alkalosis occurs under pulmonary edema due to hypobaric hypoixa.
Part 2) Metabolic acidosis takes place in chronic patients of metabolic disorder such as alcohol addicts. These patiens have impaired hepatic metabolism which causes impairments in the acid-base balance and electrolyte balance. Due to excessive intake of alcohol, the diuresis in the kidneys increaes. This causes loss of large volume of water from the body leading to accumulation of salts and ions in the body. In long run, this causes hemoconcentration due to ionic accumulation. Further, impaired ketone body metabolism further adds up to accumulation of acidic ketone bodies in the blood which further decrease the pH of the blood. This causes the an increase in the anion gap in the plasma of the patients which progresses towards decrease in overall pH of the blood and thus causing metabolic acidosis.
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