Question

4. A 4-year-old girl presents with her parents to the emergency room you work at. Her parents explain that the flu is going around her daycare and that their daughter began to feel sick 4 days ago. She has been unable to eat since then, with prolonged vomiting for 3 days. She is admitted to the hospital for rehydration and correction of her acid-base disturbance.

a. Her parents are highly concerned about how she could have developed an acid-base disturbance from the flu. How do you respond to this concern by the parents?

b. Her parents tell you that they tried to give their daughter a pediatric hydrating drink they found at the store, but she was unable to keep it down. They ask you in the future if this would have helped their daughter from developing an acid-base disturbance. How do you respond to this question by the parents?

6. A 64-year-old woman presents to the urgent care office complaining of shortness of breath and coughing up “yellow mucus.” She has a history of smoking one pack a day for 20 years and renal failure. Upon examination, she is noted to have a fever and low blood pressure. After a chest x-ray, she is diagnosed with right lower lobe pneumonia with subsequent sepsis and a resultant metabolic acidosis. The patient is admitted to a local hospital for intravenous antibiotics and further observation.

a. As her health care provider, what sequence of events led to her developing metabolic acidosis? How did her body attempt to compensate for this?

b. How would her renal failure have affected her compensatory mechanisms?

Answer 1

4(a)

Since the baby had continuous vomiting for 3 days it can lead to imbalance in electrolyte.it can either causes metabolic acidosis or alkalosis.

Metabolic acidosis occur due to dehydration of the baby due to prolonged vomiting that too lactic acidosis as lactic acid builds up due to dehydration

Metabolic alkalosis occur since severe vomiting  causes loss of potassium (hypokalemia) and sodium (hyponatremia). The kidneys compensate for these losses by retaining sodium in the collecting ducts at the expense of hydrogen ions (sparing sodium/potassium pumps to prevent further loss of potassium), leading to metabolic alkalosis.

Due to prolonged vomiting blood has too much bicarbonate that is metabolic alkalosis.

It can also lead to hypochloremic alkalosis due to lose of chlorine through vomiting

4(B) ask the parents to rehydrate the baby and to hospitalize as aerly as possible

6(a) Respiratory acidosis develops when the lungs do not expel carbon dioxide adequately (inadequate ventilation), a problem that can occur in disorders that severely affect the lungs (such as chronic obstructive pulmonary disease, severe pneumonia, heart failure, and asthma).since she had mosy of this problem,it can lead to acidosis.

The body compensate by removing acid from the body through urine.

(b) Metabolic acidosis occur as she is a  chronic kidney disease (CKD) patient and a chrnic smoker, and its causes are: impaired ammonia excretion, reduced tubular bicarbonate reabsorption and insufficient renal bicarbonate production in relation to the amount of acids synthesised by the body and ingested with food