Case #4 Dillon is a 55 lb., 6-year-old male who fell into a freshwater lake while duck hunting with his father. Dillon was unaccounted for 15-20 minutes until his body was found floating face down in the water. He was immediately pulled out and basic life support was started. Upon arrival at the hospital, his arterial blood results were as follows: pH = 6.90; PaO2 = 49 mmHg; PaCO2 = 54 mmHg; and HCO3- = 24 mEq/L. 1. What is Dillon's acid-base abnormality? 2. What is the specific cause of his acid-base abnormality? Explain your answer. Case #5 Two patients, both in respiratory distress, present to your hospital when you have only a single ventilator available. Each has a history of emphysema and each wants ""everything possible done."" Results of arterial blood testing of the first patient show PaO2 = 68 mmHg, PaCO2 = 58 mmHg, and HCO3-= 22 mEq/L. Results for the second patient are PaO2 = 59 mmHg, PaCO2 = 75 mmHg, and HCO3-= 38 mEq/L. All else being equal and based purely on arterial blood analysis, which patient should get the ventilator? (Hint: The ventilator will be most useful to the patient
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Case Study #4 A 65-year-old female who was a lifelong smoker visited her doctor because she was having difficulty breathing. This was nothing new but seemed to be getting worse. It was most difficult to exhale, but it helped if she pursed her lips. After her examination, her doctor prescribed an oxygen tank for her use at home and ordered the following tests: Test Normal Range Patient's Results FVC (Forced Vital Capacity) 2.07 L 1.8 L FEV1.0 (Forced Expiratory Volume in 1 sec) 1.7 L 0.9 L FEV% FEV1.0/FVC 77% 50% MVV (Maximum Voluntary Ventilation) 80-120 L/min 75 L/min FRC (Functional Residual Capacity) 2.4 L 3.0 L ERV (Expiratory Reserve Volume) 1.2 L 0.8 L RV (Residual Volume) 0.5 L 2.2 L Arterial Blood Gas PO2 = 95 mmHg PCO2 = 40 mmHg pH = 7.38-7.42 PO2 = 85 mmHg PCO2 = 46 mmHg pH = 7.39 ECG Mean Electrical Axis Between +110 to -20° +130° 1. What would be the specific diagnosis for this patient? 2. Which of the following test results above would support this diagnosis? List all that apply. 3. Explain why the RV in this patient has increased. 4. Why is this patient's Arterial Blood Gas measurement abnormal? Is it the increase in PCO2 or the decrease in PO2 that caused the change in her blood pH? Explain. 5. Does her heart have a normal Mean Electrical Axis? If it is abnormal, explain what led to this.
Madhur L.
31 Acidosis occur due to any of the following except: a. Pulmonary fibrosis b. Chronic renal failure c. Prolonged vomiting d. Uncontrolled DM e. Severe diarrhea 41 A 54 old male patient states he have been vomiting for the last 4 days. The patient is irritable, weak, and reporting muscle cramping and weakness. On assessment, the patient is experiencing bradypnea with a respiratory rate of 10. The patient has the following ABGs result: HCO3 36, pH 7.52, PaCO2 48. What type of compensation is taking place in this case ? a. Respiratory by hypoventilation b. No compensation is taking place in this patient c. Respiratory by hyperventilation d. Renal compensation by increasing excretion of H+ e. Renal compensation by increasing reabsorption of HCO3- 51 In a man undergoing surgery, it was necessary to aspirate the contents of the upper gastrointestinal tract. After surgery, the following values were obtained from an arterial blood sample: pH 7.55, PCO2 52 mm Hg and HCO3 - 40 mmol/l. What is the underlying disorder? a. Metabolic Alkalosis, partially compensated b. Metabolic Alkalosis, uncompensated 61 All are causes of hyperphosphatemia except: a. Potassium deficiency b. Hypoparathyroidism c. Seizures d. kidney failure e. Lack of vitamin D 71 A 64-year-old man with a history of COPD presents with worsening shortness of breath and increased sputum production. His ABGs reveal the following values pH: 7.21 pCO2: 60 HCO3: 29 The acid-base status best described as: a. Fully compensated respiratory acidosis. b. Uncompensated metabolic acidosis. c. Partially compensated metabolic alkalosis d. Partially compensated respiratory acidosis. e. Fully compensated metabolic acidosis. f. Fully compensated metabolic alkalosis
Sri K.
A.C. is a 79-year-old man living in a long-term care facility. He has had multiple medical diagnoses, including heart failure (HF), chronic obstructive pulmonary disease (COPD), and a stroke. He is bedridden and receiving enteral tube feedings. He has chronic diarrhea thought to be related to his tube feedings. He receives digoxin and furosemide (Lasix) to manage his heart failure. 1. A.C. is prone to several acid-base and fluid-electrolyte disorders. Which of the following is/are true for this patient? (select all that apply) a. Hypokalemia b. Respiratory acidosis c. Hypernatremia d. Saline excess How would A.C. attempt to compensate for respiratory acidosis should it occur? (select all that apply) a. Compensation through renal excretion of bicarbonate ions. b. Compensation through renal production of more bicarbonate ions. c. Compensation through hyperventilation. d. Compensation through hypoventilation. 3. What acid-base imbalance might occur as a result of A.C.'s chronic diarrhea? (select all that apply) a. Metabolic alkalosis b. Respiratory alkalosis c. Metabolic acidosis d. Respiratory acidosis Case-2: Patient History L.S. is brought to the emergency department for management of acute mushroom poisoning. Her respirations are slow and shallow, and she is nonresponsive. She is admitted to the critical care unit to be closely monitored for the development of respiratory failure and renal failure, which often accompany mushroom poisoning. Her urine output is decreased to about 20 ml/hr. Her laboratory values are serum K+ = 5.7 mEq/L; arterial blood gases (ABGs): pH = 7.13, PaCO2 = 56 mm Hg, PaO2 = 89 mm Hg, HCO3- = 18 mEq/L. Analyze this case study and answer the next four questions that follow. Case-2 Question-1 What is the most likely cause of L.S.'s potassium imbalance? (select all that apply) The most likely cause of L.S.'s potassium imbalance is her shallow breathing. The most likely cause of L.S.'s potassium imbalance is impaired kidney function. The most likely cause of L.S.'s potassium imbalance is respiratory failure. The most likely cause of L.S.'s potassium imbalance is renal failure.
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