The arterialblood PH is higher than the normal levels, high level of HCO3- andnormal level of PaCO2, PaO2 and SaCO2 indicate that the lady wassuffering from metabolic alkalosis. Vomiting indicates that thepatient’s stomach walls were producing a lot of hydrogen ions. Thehigh levels of HCO3- in the arterial blood, implies that there is aloss of intracellular HCO3-. The HCL that is lost by vomiting in thestomach results in high levels of HCO3-. This condition is associatedwith defective absorption of chlorine in the intestines which in turncauses depletion of potassium and movement of hydrogen ions into thecell (intracellular). The shift of hydrogen ions into the cell is notcoupled with proportional HCO3- thus leading to the removal of theintracellular HCO3-. The renal production of HCO3- increases and issubsequently retained in the blood (Gillenwater, J. Y., 2001).
Metabolicalkalosis is caused excessive ingestion of alkalis. The patient usedmore antacids than the prescriptions, and this increased the levelsof alkali ingested in the body.
As mentionedearlier, vomiting played a significant role in causing metabolicalkalosis. This resulted in difficulties in keeping food that mayhelp in resolving the condition by providing the necessary compoundslacking in the body system. Since the patient had the flu, she hadnasogastric tube drainage with no replacement of electrolytes as shewas not able to keep drinks and foods that provide the electrolytes.
There arechemical buffers that bind intracellular and extracellularbicarbonate in the body. Excess bicarbonate ions are unbound, andthey result in an increase in the blood PH levels, a condition thatdepresses chemoreceptors in the medulla. Respiration is inhibitedresulting in low oxygen levels, and PaCO2 is raised. 32 meq/litrelevels of bicarbonate ions in the blood exceeded the capacity of therenal tubules leading to excretion of excess bicarbonate ions andretention of hydrogen ions in the blood stream. The dehydrationresulted from the fact that there was a need for maintainingelectrolyte balance that resulted in the excretion of more sodiumions and water molecules. Low extracellular hydrogen ions causehydrogen to diffuse passively out of the cell to attain chargebalance on the cell membrane. The intracellular hydrogen ions falls,calcium ionization reduces and the permeability of the nerve cell tosodium ions increases. The sodium ions trigger generation of neuralimpulses in the PNS and finally in the CNS (.
There aremechanisms that body employs to restore the normal blood PH. Thisinvolves a process known as compensation, a mechanism that restoresthe PH of blood back to optimal levels/range. The renal responsescompensate the respiration abnormalities while the respiratoryresponses compensate metabolic abnormalities. In respiratoryresponse, the respiratory system causes hypoventilation that resultin the retention of CO2 in the blood. The carbon (IV) oxide isconverted to carbonic acid that lowers the blood pH to normal levelsto the range of 7.35 to 7.45. Metabolic Alkalosis refers to thecondition resulting from loss of acid and, therefore, the renalsystem must retain as much hydrogen ions as per their need by theblood in order to restore the blood pH to normal levels. Excessbicarbonate ions are excreted by the renal tubules to maintainelectrolyte balance in the blood (Mary L. S., Deborah G. K. &Marthe J. M. 2013).
Q5: Pharmacologicintervention for acid-base disturbance
•Administration of 0.9% saline solution intravenously
•Administration of aceyazolamide
• Hydrogenion blockers
•Administration of hydrochloric acid of dosage 0.1 mmol/kg/h.intravenously
0.9% salinesolution is used for chlorine responsive metabolic alkalosis thatresults in fluid losses and rise of chlorine in the blood to morethan 25 mEq/l. This condition restores the normal blood PH levels.However, this action cannot restore the condition completely back tooptimal PH level. Acetazolamide of 250 to 355mg doses per dayenhances the excretion of bicarbonate ions. This may also lead toloss of potassium ions and phosphate ions. The hydrogen ion blockersprevent the loss of hydrogen ions through vomiting and thereforepreventing advancement of the alkalosis to severe levels. Potassiumsupplement is used when the alkalosis is coupled with severehypokemia as the restoration will be achieved when potassium ions arerestored to an optimal level. Surgical interventions are used whenthe metabolic alkalosis is unresponsive, and it involves the removalof a tumor that produces mineralocorticoid (Mary L. S., Deborah G. K.& Marthe J. M. 2013).
Q7: Educationalneeds for the patient
The patient needseducation on management of illnesses. As indicated in the case, thelady used more antacids that the recommended dosage. The patientneeds advice and development of understanding for the importance offollowing prescriptions of medical professionals. Interventions ofacid-based disturbance need should be done quickly to avoid theseverity of the condition increasing. Management of such conditionbecomes easy when identified early. The effects of overdose and latereporting of health issues are mentioned to the patient to enable herdevelop the understanding of such conditions (Mary L. S., Deborah G.K. & Marthe J. M. 2013).
Gillenwater, J. Y. (2001). Adult and pediatric urology.Philadelphia: Lippincott Williams & Wilkins.
Mary L. S., Deborah G. K. & Marthe J. M. (2013), Introductionto Critical Care Nursing, Elsevier Health Sciences
Munson, C., Traister, R., & Lippincott Williams & Wilkins.(2005). Pathophysiology: A 2-in-1 reference for nurses.