Acid Base and Electrolyte Case Study
Assignment instructions
A nurse is taking care of an 85-year-old woman in a hospital-based skilled nursing facility. In the report, the nurse is told the patient has not been breathing well for the past 2 days. She has been lethargic, her skin is warm and dry, and she has a decreased urine output. The following laboratory findings were returned from the laboratory immediately after morning report:
Blood Chemistries
- Na: 147
- Cl: 110
- K: 4.0
Arterial Blood Gases
- pH: 7.33
- PCO2: 48
- HCO3: 27
- PO2: 96
Urinalysis
- Urine Specific Gravity: 1.040
- Identify each of the abnormal laboratory findings in the above results. Specify how they differ from a normal range and identify what condition each abnormality indicates.
- What specific electrolyte disturbance does the patient have?
- What clinical manifestations would the nurse expect to see with this electrolyte abnormality presented above?
- If the patient had an increase in her potassium level, for what clinical manifestations would the nurse monitor?
- What blood gas abnormality is seen in this patient? Discuss the rationale for your answer.
- What are the three major mechanisms of pH regulation?
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Sample Student Answer
NUR-641- Advanced Pathophysiology and Pharmacology For Nurse Educators
Electrolytes and Fluid Imbalance
Electrolytes are vital minerals in the body. They are found in tissues, urine, blood, and other body fluids. Electrolytes are used to balance the body’s pH level. They are also used to move wastes out of the cells and nutrients into the cell (Villiger et al., 2018). Electrolytes are also used to balance water in the body and ensure that body muscles, nerves, the heart, and the brain function well.
Examples of electrolytes in the body include phosphate, chloride, potassium, calcium, sodium, and magnesium (Villiger et al., 2018). In this paper, electrolyte disorders and their symptoms have been discussed. The paper has also discussed the mechanisms used to balance body pH.
Abnormal Laboratory Findings
One of the abnormal laboratory findings is sodium level. A normal sodium level in the blood should be 135-145mEq/L. However, the patient’s sodium level is 147mEq/L. A high sodium level in the blood indicates hypernatremia (Bie, 2018). The calcium level in the patient’s blood is also abnormal. The patient’s calcium level is 110mEq/L, yet the normal range is 96-106 mEq/L. A high calcium level in the body indicates the patient has hypercalcemia (Lee & Shoback, 2018). The patient’s arterial blood pH is low. Arterial blood pH should range between 7.38-7.42.
However, the patient’s blood pH is 7.33, indicating acidosis (American Association for Clinical Chemistry (AACC), 2017). The partial pressure of carbon dioxide (PaCO2) is also abnormal. The patient’s PaCO2 is 48 mm Hg, yet the normal range should be between 38-24 mmHg, indicating that the patient has respiratory alkalosis. The urine-specific gravity is also abnormal. The patient has a specific gravity of 1.040, yet the normal range should be between 1.010-1.025 and 1.003-1.030. The results indicate that the patient might have a very high glucose level.
Electrolyte Disturbance (Hypercalcemia)
The patient’s calcium level in the blood is high compared to sodium. The normal calcium range in the blood is 96-106 mEq/L. The patient’s calcium level is 110mEq/L, meaning that she has hypercalcemia. Hypercalcemia is a disorder where a person’s blood has high calcium levels. According to Lee and Shoback (2018), a high calcium level in the blood can weaken the bones, affect brain functioning, interfere with the heart, and increase the risk of developing kidney stones. The author noted that hypercalcemia occurs due to overactive parathyroid glands.
The glands are located in the neck region near the thyroid gland (Lee & Shoback, 2018). Hypercalcemia can also be caused by some medications, cancer, too many vitamin D and calcium supplements, and some medical conditions. The disorder also occurs if the digestive tract absorbs more calcium and the kidney activates more vitamin D and excretes less calcium. Vitamin D is a significant component in the absorption of calcium. Diseases that cause the condition include lung disorders, thyroid disorders, and the use of antacids.
Clinical Manifestations of Hypercalcemia
The disease symptoms include indications of cardiac arrhythmia, palpitations and fainting, confusion, fatigue, lethargy, depression, vomiting, nausea, stomach upset, and constipation (Lee & Shoback, 2018). The patient presents with most of the symptoms mentioned above. She has a breathing problem, which is an indication of cardiac arrhythmia. She also has decreased urine output and lethargy, other symptoms of hypercalcemia.
High Potassium Level
Potassium is a significant nutrient in the body. The electrolyte can be got in foods, such as dried fruits, bananas, lentils, beans, winter squash, broccoli, avocado, and potatoes. Potassium is essential in improving the function of muscles and nerves (Palmer et al., 2021). Though potassium is important in the body, high levels of electrolytes are harmful to the body. A high potassium level is also known as hyperkalemia. If the patient had a high potassium level, she would have hyperkalemia. In most cases, hyperkalemia has no notable symptoms.
The notable symptoms of hyperkalemia include chest pain, diarrhea, belly pain, vomiting, nausea, heart palpitations, fluttering, fast or irregular heartbeat, numbness in the limbs, and muscle weakness (Palmer et al., 2021). Dangerously high potassium levels in the blood can lead to life-threatening problems and heart conditions. In addition to the highlighted symptoms, a nurse should monitor the rhythm changes of the patient’s heart.
Blood Gas Abnormality
Blood gas is the measurement of carbon dioxide and oxygen in a patient’s body. Blood gas also determines the body’s pH. The sample of blood gas test is often collected from an artery using a needle. The patient has three blood gas abnormalities. The first abnormality is a higher PaCO2 level. Normal PaCO2 is between 38-24 mmHg. However, the patient has a PaCO2 level of 48 mm Hg. The second abnormality is low pH. Normal arterial blood pH is between 7.38-7.42 (AACC, 2017). However, the patient’s arterial blood pH is 7.33.
Mechanisms of pH Regulation
The body regulates pH through three significant regulation mechanisms. The first mechanism is chemical buffers. Bicarbonate (HCO3) is the most significant chemical buffer. The body uses the buffer to conduct a chemical reaction with strong bases and acids regularly to maintain its pH (Michl et al., 2019).
For instance, acidity in the body is reduced through a chemical reaction where H ion binds to hydrogen to form CO2 and water, byproducts that can be eliminated by urination and breathing. If the body pH reduces, the reaction is reversed to make it more acidic. The kidney is vital in this process. It releases Bicarbonate, a product used in this reaction. The equation that represents the chemical buffer mechanism is HCO3 + H = H20 + CO2.
The second mechanism is the respiratory system. The respiratory system regulates the amount of CO2 in the blood. The respiratory organs are vital in eliminating CO2 after hydrogen has been combined with the H ion (Hopkins et al., 2021). The system also aids in reversing the above reaction. If the blood pH is low, one will breathe rapidly to reduce the amount of Bicarbonate in the body by decreasing the amount of Co2 in the blood.
Respiration is a short-term solution to body pH problems. The last mechanism is the kidney. The kidney helps balance the body’s pH by absorbing more bases or acids as required to ensure that the body is normal (Palmer & Clegg, 2019). The kidney gets rid of excess acid in the body through urine. The organ can also produce more bicarbonate chemicals when required.
Conclusion
The abnormal laboratory findings include high sodium and calcium levels. These abnormalities indicate that the patient has hypernatremia and hypercalcemia. The patient’s calcium level is 110mEq/L, meaning that she has hypercalcemia. The disease symptoms include indications of cardiac arrhythmia, palpitations and fainting, confusion, fatigue, lethargy, depression, vomiting, nausea, stomach upset, and constipation.
The notable symptoms of hyperkalemia include chest pain, diarrhea, belly pain, vomiting, nausea, heart palpitations, fluttering, fast or irregular heartbeat, numbness in the limbs, and muscle weakness. The blood gas abnormalities include high PaCO2 levels and low pH. The body regulates pH using chemical buffer, respiratory system, and kidneys.
References
American Association for Clinical Chemistry (AACC). (2017)Pearls of laboratory medicine. https://www.aacc.org/-/media/Files/Transcripts/Pearls-of-Laboratory-Medicine/2016/Slides/Acid-Base-Disorders-Suh-Lailam-Slides.pdf?la=en&hash=D9790545E7C12778CECC550324333E646BF5A73D
Bie, P. (2018). Mechanisms of sodium balance: total body sodium, surrogate variables, and renal sodium excretion. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 315(5), R945-R962. https://doi.org/10.1152/ajpregu.00363.2017
Hopkins, E., Sanvictores, T., & Sharma, S. (2021). Physiology, acid base balance. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK507807/
Lee, J. Y., & Shoback, D. M. (2018). Familial hypocalciuric hypercalcemia and related disorders. Best practice & research. Clinical Endocrinology & Metabolism, 32(5), 609–619. https://doi.org/10.1016/j.beem.2018.05.004
Michl, J., Park, K. C., & Swietach, P. (2019). Evidence-based guidelines for controlling pH in mammalian live-cell culture systems. Communications Biology, 2(1), 1-12. https://www.nature.com/articles/s42003-019-0393-7
Palmer, B. F., & Clegg, D. J. (2019). Physiology and pathophysiology of potassium homeostasis: core curriculum 2019. American Journal of Kidney Diseases, 74(5), 682-695. https://doi.org/10.1053/j.ajkd.2019.03.427
Palmer, B. F., Carrero, J. J., Clegg, D. J., Colbert, G. B., Emmett, M., Fishbane, S., … & Weir, M. R. (2021, March). Clinical management of hyperkalemia. In Mayo Clinic Proceedings (Vol. 96, No. 3, pp. 744-762). Elsevier. https://doi.org/10.1016/j.mayocp.2020.06.014
Villiger, M., Stoop, R., Vetsch, T., Hohenauer, E., Pini, M., Clarys, P., … & Clijsen, R. (2018). Evaluation and review of body fluids saliva, sweat and tear compared to biochemical hydration assessment markers within blood and urine. European Journal of Clinical Nutrition, 72(1), 69-76. https://www.nature.com/articles/ejcn2017136
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