Question

1) A patient is admitted to the hospital in complete collapse. His blood pH is 6.8, and his HCO3- is 20 mEq/L. What diagnosis would you give and what prognosis? A medical history reveals that this patient is a chronic alcoholic.

2) A pregnant woman complains to her doctor that her ankles and feet stay swollen all of the time. She is very worried about this. As her doctor, what would you tell her?

3) Helen is a 62-year-old smoker. Her physician has diagnosed her as having emphysema that has caused her to hypoventilate. Surprisingly, when her blood pH is checked, it is 7.40. Why?

4) After traveling from Los Angeles to Denver, Claire finds she is not feeling well and checks into a clinic for help. The clinic's diagnosis is respiratory alkalosis. What has caused this problem?

5) A patient is 72 years old and was admitted to the hospital for severe shortness of breath and edema to her lower extremities. She was diagnosed with heart failure. A symptom of heart failure is generalized edema. Explain the finding of generalized edema in heart failure.

6) A 13-year-old girl is admitted to the psychiatric unit for anorexia. Her body weight is 89 lbs. and height is 64 inches. She admits to frequent self-induced vomiting and abuse of laxatives. She was treated on the medical unit with intravenous fluids. Now that she is on the psychiatric unit she is experiencing fluid retention as evidenced by mild puffiness and bloating. Explain these symptoms.

7) A patient's anxiety caused her to develop respiratory alkalosis. The nurse instructs the patient to take some slow deep breaths. Explain why this would be effective.

Answer 1

1) patient is admitted to the hospital in complete collapse. His blood pH is 6.8, and his HCO3- is 20 mEq/L. What diagnosis would you give and what prognosis? A medical history reveals that this patient is a chronic alcoholic.
The patient is suspected to have ALCOHOLIC KETOACIDOSIS. I recommend doing these tests:

• amylase and lipase tests, to monitor functioning of pancreas and assess chance for pancreatitis.
• arterial blood gas test, to know patient's blood’s oxygen levels and acid/base balance.
• anion gap to measure sodium and potassium levels.
• blood alcohol test
• Random blood glucose and HbA1c
• blood urea nitrogen (BUN) and creatinine tests, to determine functional status of kidneys.
• serum lactate test, to measure levels of lactate in the blood and assess chance for lactic acidosis.
• urine test for ketones.

2) A pregnant woman complains to her doctor that her ankles and feet stay swollen all of the time. She is very worried about this. As her doctor, what would you tell her?

​​​​​​Swelling on feet and ankles are common in pregnancy due to to increased body fluid and pressure because of growing uterus. The swelling may progress as the gestation moves its way to delivery date. This problem can be rectified easily by simple movement of the legs. Brisk walking is the usually recommended and the easiest exercise to reduce the problem of swelling in feet and ankles during pregnancy. It is also recommended to:

• Avoid long periods of standing or sitting, take a gap in between by changing the state.
• Sleep on a side
• Consume lots of fluids
• Practice kicking the feet in air
• Wear comfortable dress and avoid tight stockings or socks

3) Helen is a 62-year-old smoker. Her physician has diagnosed her as having emphysema that has caused her to hypoventilate. Surprisingly, when her blood pH is checked, it is 7.40. Why?

In this case, actually the emphysema leads to metabolic alkalosis in mild to moderate stages. This leads the patient to be have rise in blood pH. A typical compensatory respiratory response to metabolic alkalosis is hypoventilation. This causes pH correction to normal. Rise in arterial blood pH will depress the respiratory centers that results in alveolar hypoventilation which will elevate the PaCO2 and thus restore arterial pH towards the normal.

4) After traveling from Los Angeles to Denver, Claire finds she is not feeling well and checks into a clinic for help. The clinic's diagnosis is respiratory alkalosis. What has caused this problem?

Respitory alkalosis is always due to hyperventilation. Claire has experienced the effect of high altitude and decreased atmospheric pressure, and was probably under stress at a newer place which led her to breath deeper and quicker.

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