A 23- year old male has been admitted for vomiting over the last 2 days, with mi

Question

A 23- year old male has been admitted for vomiting over the last 2 days, with minimal fluid intake. He went to the emergency room of a nearby hospital and the following data was obtained upon examination and testing.

Hematology:

Hematocrit: 60%
plasma pH: 7.49 (normal is 7.35 to 7.45)
pCO2: 47 mmHg (normal is 35 to 45 mmHg)
HCO3-: 31 (normal is 22 to 26 mEq/L)

Urinalysis

Appearance: dark yellow to brown
Specific gravity: 1.025 (normal is 1.015 to 1.030)
Blood: negative
Protein: mild
pH 8.5

Questions:

1.) Define acidosis and alkalosis. In general terms how can a patient develop an acidosis, an alkalosis?

2.) What is the acid-base disorder this individual is suffering from; explain your answer using the hematological data?

3.) Has compensation occurred? If so, is it partial or complete, explain your answer?

4.) Why does the patients have an alkaline urine?

Explanation / Answer

Acidosis--It is a metabolism disorder in which the levels of hydrogen ions are high in the plasma fluid and blood of the human body. The carbonic acid maintains the levels of the hydrogen ion and bicarbonate ion in the red blood cells and interstitial fluid and plasma of the human body, and in metabolic acidosis this equilibrium of hydrogen ions and bicarbonate ions is disturbed in renal cells as well the partial pressure of carbon dioxide gets altered in lungs. The changes alos takes place place due to defects in the bicarbonate and chloride ions channel in the membrane of renal cells or potassium and hydrogen ion channel or sodium and hydrogen ion channel in the membrane of renal cells.This further leads to the lowering of pH of blood below 7.

Alkalosis--It is a condition in which the levels of bicarbonate are altered in the blood and plasma due to which the pH is raised leading to alkaline conditions. The buffer equilibrium of the bicarbonate buffer system is altered in the red blood cells and the transport of bicarbonate, hydrogen and chloride are altered due to defects in these ion pumps in the renal kidney membrane and the partial pressure of carbon dioxide gets altered in lungs. The carbonic acid breaks down to form carbon dioxide gas and water in red blood cells by the action of enzyme carbonic anhydrase and in metabolic alkalosis this equilibrium is altered.

3)The patient is suffering from respiratory/metabolic acidosis and respiratory/metabolic alkalosis.

4)No, compensation has not occured in this patient condition for metabolic acidosis condition as the symptoms in this case include the increase in the amount of carbon dioxide gas in the lungs and fall in the partial pressure of carbon dioxide by 1-2mmHg whereas in this case the partial pressure of carbon dioxide has increased beyond the range.

Yes, the compensation has occured for metabolic alkalosis condition as the amount of gases in the lungs decrease and ventilation is less and the partials pressure of carbon dioxide has increased more than the standard range in the given patient case study.

4)The patient has an alkaline urine due to more secretion of bicarbonate ions from the kidney and retention and reabsorption of other ions in the kideny tubules and collecting duct due to which the pH of urine has raised to pH=8.5.

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