Question

PATH 3505 – ACUTE CARE CASE STUDY

Patient and Setting: CM is a 45-year-old man, on an inpatient surgical unit

Chief Complaint: Sudden onset of nausea/vomiting, some difficulty breathing, change in status

History of Present Illness: CM is in hospital, day 2 post-ORIF fractured femur with significant haemorrhage and other soft tissue injuries, sustained in an MVA.  CM reports that his feet are swelling, (+) fatigue, (+) nausea and vomiting, and (+) SOB. He has also noticed a decrease in urine output , although he reports he has not been eating or drinking much.

Medical History: Hypertension (×5 yrs), MVA

Surgical History: N/A (other than current hospitalization)

Family History: Mother: DM; Father: died at age 50 due to MI

Social History: Ethanol intake: Nil; tobacco: once/month

Medications:

Lisinopril 40 mg PO BID for 5 years

ASA 81 mg po daily

Rosuvastatin 20mg po daily

Amlodipine 10 mg PO QD for 2 years

Ibuprofen 800 mg PO TID for back pain

Centrum One 1 tab PO QD

Allergies: Morphine (tongue swelling, itching, rash, SOB)

Physical Examination:

GEN: Well-developed, nourished man

VS: BP 190/100, HR 83, RR 26, T 37.3°C, Wt 80 kg, Ht 182 cm

HEENT: WNL

CHEST: Small crackles, rales, and wheezing

ABD: WNL

EXT: Bilateral LE swollen with fluid, 3+ pitting edema

NEURO: A & O ×2 (place, time)

Results of Pertinent Laboratory Tests, Serum Drug Concentrations, and

Diagnostic Tests:

Na 132 K 5.9  

Hgb 88 Hct 0.34   Creatinine 189 BUN 23  

Blood Gas: pH 7.3; pCO2 40; HCO3 18; pO2 97

Urine Output: 300 mL/24 hr

CASE QUESTION

1.How does renal failure cause metabolic acidosis?  What values in CMs blood gases indicate metabolic acidosis?

Note: please answer in detail and put the website you get the information, I post this questions couple days ago someone answered incomplete.

Answer 1

1. Renal failure causes metabolic acidosis.

Rationale : Kidneys excreting more amount of alkalies from the body or the amounts of acids produced in the body were not properly excreted by the kidneys.

Values of CM blood that indicates metabolic acidosis

Usually metabolic acidosis can be determined by arterial blood gases and measurement of serum electrolytes.

Normal bicarbonate levels should be 21 - 28 mEq/L , CMs bicarbonate levels are 18 which is low.Normal PH levels should be 7.40 and above but CMs value is 7.3.His partial carbondioxide level is 40 which is low and usually this should be greater than 40.

More important serum electrolyte given in CMs laboratory test is Sodium and Potassium. These electrolytes in urine also determines metabolic acidosis.Normal sodium levels should be 135 to 145 mEq/L.CMs level is 130 which is low.Normal potassium levels should be 3.5 to 5mEq/L. CMs value is 5.9 which is high.These levels indicates metabolic acidosis that is lesser Sodium concentration and higher Potassium concentration.