The state of having excess acid is referred as acidosis while that of having excess bases in the body is characterized as alkalosis. Additionally, the overall state of imbalance between acids and bases in the body is termed as the acid-base disturbance. In the human body, the four primary forms of acid-base disturbance include respiratory acidosis, metabolic acidosis, respiratory alkalosis as well as metabolic alkalosis. This case analysis focuses on acid-base disturbance, by discussing the condition's classification, its causes, explaining how renal and respiratory system compensates for the condition, describing its pharmacological intervention and outlining the educational needs for the patient.
Classification of the Patient's Acid-Base Disturbance
The tests performed on the patient portrayed that she has a very high level of bicarbonate (HCO3-) in her metabolic system. Additionally, this is because her HCO3- was at 32meg/liter far above the normal levels of 22-26meg/liter. As such, it is evident that the patient's acid-base disturbance classification is metabolic alkalosis. Moreover, this classification can also be supported by the symptoms of metabolic alkalosis, which can be observed by the patient. In this case, the symptoms evidenced in the patient that indicate the presence of metabolic alkalosis include occasional vomiting, dehydration, and nausea (Suki & Massry, 2012).
Possible Factors Causing the Acid-Base Disturbance
There are four primary factors that could have caused the metabolic alkalosis to occur in the patient. First, the condition could have been caused by the GI acid loss through the occurrence of conditions like Congenital Chloridorrhea as well as Villous Adenoma. However, in this patient, it is highly likely that the gastric acid loss occurred in her body due to her occasional vomiting, a condition also referred as nasogastric suction. Second, the metabolic alkalosis in the patient could also have occurred due to the presence of renal acid loss, a condition caused by both primary and secondary hyperaldosteronism.
Third, metabolic alkalosis in the patient could also have been caused by the presence of excess HCO3-. In this case, such excessiveness in the levels of HCO3- could have been caused by factors such as milk-alkali syndrome, post-organic acidosis and NaHCO3 loading (MSD Manuals, 2018). Lastly, metabolic alkalosis in the patient could have been caused by contraction alkalosis due to the occurrence of diuretics (MSD Manuals, 2018). In this case, the level of NaCl in the patient's body could have declined to cause a resultant concentration of the levels of HCO3- in the body (MSD Manuals, 2018).
Renal and Respiratory Systems' Compensation for the Acid-Base Disturbance
In the respiratory system, the lungs can hold on to the acid in the body via Carbon Dioxide (CO2 ), as a strategy to compensate for the metabolic alkalosis. In this case, the respiratory system decreases its ventilation properties to retain CO2, in the body (Rhoades & Bell, 2009). Furthermore, the renal system also compensates for metabolic alkalosis in the body through retaining a high level of CO2 in the lungs that is controlled through slower breathing, as well as hypoventilation (Rhoades & Bell, 2009). Consequently, the retained CO2 is later used in the formation of carbonic acid intermediates, which aids in reducing the level of PH in the body.
Pharmacological Interventions for the Acid-Base Disturbance
The treatment and management of metabolic alkalosis are dependent on the level of acid-base disturbance in the patient. In the featured case, the regular vomiting of the patient can be treated by using antiemetic drugs. Additionally, if a continued gastric suction in the patient is necessary, the state of gastric acid secretion in the patient can be minimized using H2-blockers or proton-pump inhibitors. Ultimately, if the patient is on loop diuretics, she can be issued acetazolamide as well as potassium-sparing diuretics to treat metabolic alkalosis.
Education Needs of the Patient
First, the patient should be trained on how to recognize symptoms of metabolic alkalosis in the future. Additionally, such factors are inclusive of vomiting, nausea, and dehydration among others. Second, the patient should also be taught on how to self-administer drugs by herself in the event she develops the acid-base disorder. For instance, the patient could be taught how to use antiemetic drugs, H2-blockers and proton-pump inhibitors as effective clinical interventions for managing metabolic alkalosis. Nevertheless, in case of severe cases of acid-base inhibitors, it is advisable for the patient to visit a qualified doctor for treatment.
In conclusion, the overall state of imbalance between acids and bases in the human body is termed as the acid-base disturbance. Additionally, metabolic alkalosis is one of the classifications of acid-base disturbance that is characterized by a very high level of bicarbonate HCO3. Some of the major symptoms in a patient that indicate the presence of metabolic alkalosis include occasional vomiting, dehydration, and nausea. Furthermore, the possible factors that cause an acid-base disturbance include GI acid loss, renal acid loss, the presence of excess HCO3 as well as the occurrence of diuretics. Also, in the respiratory system, the lungs can hold on to the acid in the body via CO2, as a strategy to compensate for the metabolic alkalosis. Moreover, the renal system also compensates for metabolic alkalosis in the body through retaining a high level of CO2 in the lungs. Lastly, metabolic alkalosis can be treated by using antiemetic drugs, H2-blockers, and proton-pump inhibitors.
MSD Manuals. (2018). Causes of Metabolic Alkalosis. Retrieved from MSD Manuals: https://www.msdmanuals.com/professional/endocrine-and-metabolic-disorders/acid-base-regulation-and-disorders/metabolic-alkalosis
Rhoades, R., & Bell, D. R. (2009). Medical Physiology: Principles for Clinical Medicine. Philadelphia: Lippincott Williams & Wilkins.
Suki, W. N., & Massry, S. G. (2012). Therapy of Renal Diseases and Related Disorders. Berlin: Springer Science & Business Media.
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