The Acid Base Disturbance - Essay Example

Acid-Base Case Study Angelique Harris Grand Canyon Advanced Pathophysiology and Pharmacology for Nurse Educators NUR-641E April 18, Acid-Base Case Study The acid base disturbance in this patient is caused by a condition known as metabolic alkalosis. Consequently, this state occurs when the PH of the blood in arteries rise above 7.45 which is the maximum PH. The pH above 7.5 is termed as alkalemic. A general decline in hydrogen ion concentration or a surplus of base leads to alkalosis. Considering the case study, the pathophysiology of metabolic alkalosis is common and generally occurs when bicarbonate is increased.

This is caused by excessive loss of metabolic acids especially on excessive vomiting. Acid loss is because of vomiting due to lowering of extra fluid outside the cell together with chloride ions. Consequently, renal replenishment is not very effective. This is because the body may try to return such an imbalance to normalcy but the level of bicarbonate and carbon dioxide will remain destabilized (Lehne, 2012). In this case, study, metabolic alkalosis causes a HCO3 to shift above 26 meq/L with a pH above 7.

45 but Paco2 remains normal. Additionally, the release of hydrogen ions causes an increase in sodium and bicarbonates retake by the kidney. The role of Bicarbonate is to maintain an anionic balance. This is because the chloride ions in the fluid outside the cell are decreased significantly. Due to decreased concentration of potassium, hydrogen ion moves to space outside the cell to maintain an electrochemical balance. Fluids excreted outside the cells and organ like kidney remain acidic (Lehne, 2010).

However, this fluid outside the cell can be returned to normalcy with a mix of sodium chloride and potassium ("Acidosis and Alkalosis: Acid Base Disorders," 2012). The volume substitution decreases renal capability to reabsorb Na+ and chloride ions. The replaced bicarbonate are now released inform of urine and hydrogen ion excretion decreases. This causes PH to return to its normal state (Lehne, 2010). The body has its own correction mechanism for metabolic alkalosis. Consequently, breathing above normal rate causes retention of CO2, increased renal excretion of bicarbonate and buildup of organic acids.

When alkalosis is likely to be fatal direct correction mechanism are usually applied. This can be done by administering a standardized dose of dilute hydrochloric acid through vein in central nervous system catheter or by administering an acid forming salt. However, ammonium chloride must not be administered to patients with known conditions of liver such as liver failure because the drug is likely to cause brain failure and damage in these patients (Lehne, 2010). In most acid base disorders both HCO3 and PCO2 are either below or above normal range, in this case HCO3 is out of range.

This condition is characterized by many symptoms main one being increased rate and depth of breathing, puzzlement, breathing difficulty, and increased rate of respiration ("Acidosis and Alkalosis: Acid Base Disorders," 2012). To regain acid base balance the lungs may react to a metabolic abnormality, and the kidneys will react to a respiratory abnormality. Breathing mechanism or excretion by the kidney does not solve this abnormality (Lehne, 2012). Understanding Acidosis and Alkalosis Respiratory acidosis develops when the lungs fails to adequately get rid of CO2 while excessive respiration may result from diseases that severely affect the lungs, nerve damages and muscles of the chest that weaken the work of breathing.

Additionally, some drugs slow down a patient’s rate of breathing. In respiratory acidosis, the blood pH is below 7.35 and a Paco2 above 45 mm Hg but HCO3 is normal. In addition, elimination of too much carbon dioxide by the lungs lead to development of respiratory alkalosis and it is most significant in increased rate of breathing. Actually, pH is above 7.45 and a Paco2 below 35 mm Hg. In spite of this abnormality, HCO3 remains normal (Foumier, 2009). Metabolic Acidosis can result from intake of an acidic substance or a substance that can be broken down to an acid.

Moreover, there may be production of excess acid, or kidney may not be able to play its role of eliminating acid from the body. A loss of base from major organs may also result to this condition. In this scenario PH, also become lower. Metabolic alkalosis can result from loss of stomach acid, excessive loss of essential ions such as sodium, and loss of hydrogen ions in the kidney tubules. This condition can also result to high rate of respiration (Foumier, 2009). Educational Needs and Approach Keeping in mind several factors that can make ABG results erroneous such as using unauthorized technique to draw the arterial blood sample, drawing venous blood instead of arterial blood, drawing an ABG sample before stipulated time after procedure, allowing air bubbles in the sample and delaying specimen delivery to the to the lab.

Always perform a clinical assessment, and judgment. As a nurse, you are answerable to your patients because you are constantly at bedside taking note of any changes in condition. Nurse role is closely monitoring any complication that may arise due to this imbalance such as disruption of major organs in the body (Foumier, 2009). In conclusion, homeostatic control in the body is important. Therefore, it is the role of nurse to monitor patients facing any homeostatic disruption. References Foumier, M. (2009). Perfecting your Acid-Base Balancing Act.

Retrieved from http://www.americannursetoday.com/article.aspx Lab Test Online Acid Base Disorders. (2012). Retrieved, from http://labtestonline.org/understanding/conditions/showall/html Lehne, R. A. (2012). Pharmacology for Nursing Care. New York: Elsevier Health Sciences