A 68 y/o male diagnosed with congestive heart failure presents to his physician
ID: 3476470 • Letter: A
Question
A 68 y/o male diagnosed with congestive heart failure presents to his physician with distended jugulars and pitting edema of the ankles. His breathing is rapid (20 breaths/min) and pulmonary rales (crackles) are heard bilaterally in the lower lobes of the lungs. He has a pulse rate of 110 beats/min and a BP of 140/88. Blood work shows:
Blood
Values
Urine
Values
Na+ (mEq/L)
128
Na+ (mEq/L)
110
K+ (mEq/L)
3.9
K+ (mEq/L)
80
Mg2+ (mg/dL)
1.7
Mg2+ (mg/day)
19
Ca2+ (mg/dL)
8.9
Ca2+ (mg/day)
105
HCO3 (mEq/L)
30
HCO3
1.7
Creatinine (mg/dl)
1.7
Creatinine (mg/L)
2080
PAH (mg/ml)
0.013
PAH (mg/ml)
5.91
Glucose (mg/dL)
85
Glucose
0
BUN (mg/dL)
14
24hr volume (L)
1.2
pCO2 (mmHg)
45
Osmolarity (mOsm/L)
750
pH
7.31
pH
6.8
Is this Px experiencing an acid-base imbalance? If so, what type and how would the body compensate for this imbalance? Explain (use cellular mechanisms and diagrams)
Blood
Values
Urine
Values
Na+ (mEq/L)
128
Na+ (mEq/L)
110
K+ (mEq/L)
3.9
K+ (mEq/L)
80
Mg2+ (mg/dL)
1.7
Mg2+ (mg/day)
19
Ca2+ (mg/dL)
8.9
Ca2+ (mg/day)
105
HCO3 (mEq/L)
30
HCO3
1.7
Creatinine (mg/dl)
1.7
Creatinine (mg/L)
2080
PAH (mg/ml)
0.013
PAH (mg/ml)
5.91
Glucose (mg/dL)
85
Glucose
0
BUN (mg/dL)
14
24hr volume (L)
1.2
pCO2 (mmHg)
45
Osmolarity (mOsm/L)
750
pH
7.31
pH
6.8
Explanation / Answer
1. Normal pH AOF Blood is 7.35 to 7.45
2. In this case pH is 7.31 which points towards acidosis.
3.in this case increased HCO3 ( normal 22 to 28) points towards METABOLIC ALKALOSIS.
4. Increased pCO2 ( normal 38 to 42) points towards RESPIRATORY ACIDOSIS . this acidosis is compensating the metabolic changes.
5. Hence it is COMPENSATORY METABOLIC ALKALOSIS.
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