CASE STUDY A 4. What serum pH could be expected in Mr. K.B. after this early vom

Question

CASE STUDY A 4. What serum pH could be expected in Mr. K.B. after this early vomiting? 5. Describe the compensations for the losses of fluid and Vomiting Mr. K.B. is age 81 and has had gastritis with severe vomiting for 3 days. He has a history of heart problems and is presently feeling dizzy and lethargic. His eyes appear sunken, his mouth is dry, he walks unsteadily, and he complains of muscle aching particularly in the abdomen. He is thirsty but is unable to retain food or fluid. A neighbor has brought Mr. K.B. to the hospital, where examination shows that his blood pressure is low, and his pulse and respirations are rapid. Laboratory tests demon strate elevated hematocrit, hypernatremia, decreased serum bicarbonate, serum pH 7.35, and urine of high specific gravity (highly concentrated). electrolytes that should be occurring in Mr. K.B. 6. Explain why Mr. K.B. may not be able to compensate for losses as well as a younger adult. Part B: Days 2 to 3 As Mr. K.B. continues to vomit and is still unable to eat or drink any significant amounts, loss of the duodenal contents, which include intestinal, pancreatic, and biliary secretions, occurs. No digestion and absorption of any nutrients occurs. Losses at this stage include water, sodium ions, potassium ions, and bicarbonate ions. Also, intake of glucose and other nutrients is minimal. Mr. K.B. shows elevated serum sodium levels This case study illustrates a combination of fluid, electro lyte, and acid-base imbalances. Specific laboratory values are not given so as to focus on the basic concepts. For clarity, this case study is discussed in three parts, the early stage, middle stage, and advanced stage of the imbalances. Further informa tion about the specific problems involved is given in each part and is followed by a series of questions 7. Explain why serum sodium levels appear to be high in 8. Explain how high serum sodium levels might affect the 9. Using your knowledge of normal physiology, explain how this case intracellular fluid Part A: Day 1 Initially, Mr. K.B. lost water, sodium in the mucus content, and hydrogen and chloride ions in the hydrochloric acid portion of the gastric secretions continued fluid loss is likely to affect: a. blood volume b. cell function c. kidney function 10. Given Mr. K.B.'s history, why might potassium imbalance Alkalosis develops for two reasons, the first being the direct loss of hydrogen ions and the second being the effects of chlo ride ion loss. When chloride ion is lost in the gastric secretions, it is replaced by chloride from the serum (see Fig. 2-9). To maintain equal numbers of cations and anions in the serum, chloride ion and bicarbonate ion can exchange places when needed. Therefore more bicarbonate ions shift into the serum rom storage ride ions. More bicarbonate ions in the serum raise serum pH and the have more serious effects on him? Part C: Day 3: Admission to the Hospital After a prolonged period of vomiting, metabolic acidosis devel ops. This change results from a number of factors Loss of bicarbonate ions in duodenal secretions .Lack of nutrients leading to catabolism of stored fats and s in the erythrocytes to replace the lost chlo protein with production of excessive amounts of ketoacids Dehydration and decreased blood volume leading to decreased e Decreased blood volume leading to decreased tissue ult is "hypochloremic alkalo n of acids by the kidn to be affected i Which compartme by early fluid l cas per fu s oxygen to cells, and i an obic 2. Exp how a loss of sodium i ribu metabolism with increased l cid dehydra ased muscle activity and stre adi ng sed 3. Describe signs of dehydra Mr. K.B. metabolic acid productio

Explanation / Answer

Part a-
1. Scientist Senay reported that water is lost from the plasma at the rate 1 to 5 times that of other fluid compartments during dehydration.
Costill demonstrated the relative greater plasma water loss to movement accompanying the major ions lost in sweat and urine which are the extracellular compartment.

2. Sodium is an electrolyte, an electricaly charged molecule which is vital to the body functions. sodium is involved in the functioning of muscles, balance of fluids in the bloodstream and electrical processes which establish a healthy heart rhythm. Imbalance in sodium level leads to dehydration that is loss of water from the body.

3. Increased thirst
Dry mouth.
Tired and sleepy.
Headache.
Dry skin.
Decreased urine output.

4. The serum pH level will increase.

part B-

7. When water loss exceeds sodium loss, the sodium level in the blood becomes abnormally high.

8. hypernatremia causes fluid shift out of the cells that is it causes decrease in intracellular fluid volume.

9.a intracellular fluid volume decreases and extracellular fluid volume increases.
b. Cells are primarily water and dehydration causes an electrolyte imbalance which affects cell function.
c. The kidney function is impaired. Urine output is decreased.

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