Understanding and Managing Acid-Base Imbalance

Acid-base Imbalance Case Study Acid-base imbalances are seen in the emergency room daily. The ability to diagnose and treat depends on determining the patients underlying cause and understanding how to treat it. A 22 year old women has been presented in the emergency room with flu-like symptoms, excessive vomiting, unable to tolerate food, and taking high doses of antacids for eight days (GCU, 2010). Arterial blood gases and IV fluid have been started. The following paper will analyze the blood results to determine the acid-base disturbance, pathophysiologic factors that lead to this imbalance, how the body compensates, pharmacology intervention, and patient education.

Classifying Patient Acid-base Disturbance In classifying this patient’s

The most common cause of metabolic alkalosis is an increase of pH and an increase in HCO3 (Lehne, 2013). This occurs as the body loses hydrogen ions. Hydrogen ions are rich in the gastric secretions which is lost when a person is continually vomiting. When the hydrogen ions are excreted, a bicarbonate ion is gained in that extracellular space causing a buildup in the stomach. It continues to manifest as alkalemia (pH> 7.40). The body’s compensatory mechanism tries to stabilize bicarbonate levels. This leads to alveolar hypoventilation with a rise in arterial carbon dioxide tension (PaCO2) and diminishes the changes in pH that would normally occur (Lehne, 2013). Ingestion of large amounts of non-absorbable antacids can also generate metabolic alkalosis. “When magnesium hydroxide, calcium or aluminum with a base hydroxide or carbonate, the hydroxide anion buffers hydrogen ions in the stomach” (Schreiber, 2013).The cation binds to the bicarbonate that is secreted by the pancreas and is excreted out of the body. In a normal functioning body, both hydrogen ions and bicarbonate are loss without any acid-base disturbances. When there is an increase of sodium bicarbonate, they do not bind with the cation and are reabsorbed causing an imbalance (Schreiber, 2013). Sodium bicarbonate amounts exceed the capacity of the kidneys and cause

Antiemetics would be administered to reduce vomiting. 0.9% normal saline at 50-100 ml rate would be given to correct fluid losses. If continuous gastric suction is necessary, an H2 blocker or PPI would be added to decrease gastric secretions and let the stomach rest. Supplements with potassium would be given to prevent hypokalemia from volume resuscitation. Labs to monitor electrolytes in the blood and urine would be done. Vital signs to monitor blood pressure, pulse, respirations, oxygen levels, and temperature for any dynamic