Which patient needs to be assessed first based on the information above? Why?
From the lab results acquired above, patient B should be assessed first. This is because the patient has an abnormal electrolyte balance with a high potassium value and HCO3 while the calcium and magnesium are low. The normal pCO2 is between 35 mm Hg to 45 mm Hg yet patient B records 48 mm Hg. The value is high placing the patient at risk to contract respiratory acidosis which may in turn cause choking and obstruction of the airway which may be disastrous. Also, normal K+ levels lie between 3.5 mEq/L to 5.0 mEq/L yet patient B records 6.1 mEq/L which may lead to cardiac arrest (Thomsen et al., 2018). Normal Mg+ lie between 1.5 mg/dL and 2.5 mg/dL yet patient B records 0.9 mg/dL which is lower than normal. Lastly, a normal HCO3 lies between 22 mEq/L and 26 mEq/L yet patient B records 28 mEq/L which is an indication of metabolic alkalosis.
What could be some possible causes of the hyperkalemia?
Hyperkalemia is often defined as the excessive concentration of potassium in the blood especially when the levels exceed the standard value ranging between 3.5 mEq/L to 5.0 mEq/L (Thomsen et al., 2018). The possible causes of hyperkalemia include excessive intake of potassium supplements, a decreased secretion of potassium from the intracellular and intracellular space, acute kidney failure, chronic kidney disease, and dehydration (Terker et al., 2015). Other causes include the excessive use of uncontrolled diabetes, beta blockers, and destruction of the red blood cells due to fatal burns or injuries that lead to excessive bleeding.
Patient B is also complaining of numbness and tingling, especially around the mouth. What are the other two electrolyte imbalances in this patient that could be causing these symptoms?
Based on the data, the possible electrolyte imbalance that may cause numbness and tingling on patient B include the high Potassium levels and low calcium levels. As discussed earlier, normal potassium lie between 3.5 mEq/L to 5.0 mEq/L yet patient B records 6.1 mEq/L which is higher than normal. Similarly, normal calcium levels lies between 8.5 mg/dL to 10.2 mg/dL yet patient B records 7.5 mg/dL which lower than normal.
Discuss the possible etiology associated with each electrolyte imbalance identified in question number 3.
The possible etiology of the electrolyte imbalance in the question above could be due to the following; The high potassium levels could as a result of high intake of potassium supplements, kidney failure such that it does not work properly limiting the secretion of potassium, dehydration, and destruction of the red blood cells (Terker et al., 2015). On the other hand, low calcium levels may be caused by low intake of proteins, kidney failure, improper functioning of the parathyroid gland, and excessive drugs with high levels of phosphorus.
What manifestations (symptoms) are associated with the three electrolyte imbalances in Patient B?
The symptoms of high potassium include numbness and tickling, nausea or vomiting, irregular heartbeats, bradycardia, pain in the chest, fatigue, and difficulties in breathing (Thomsen et al., 2018). Symptoms of low calcium include muscle pain, memory loss, depression, hallucinations, numbness and tickling in the face, hand, and feet. Low magnesium is associated with irregular heartbeat, asthma, muscle cramps, and mental illness (DiNicolantonio, O'Keefe & Wilson, 2018).
How would you interpret Patient B's arterial blood gases?
From the lab results, it is revealed that the arterial blood gases exhibited by patient B indicate a metabolic acidosis condition since the PH is low while the bicarbonate levels are high. The normal PH levels in blood range between 7.35 to 7.45 yet patient B records 7.32 which fall below the normal level range. Similarly, patient B exhibits a bicarbonate level of 28 mEq/L which is higher as compared to the normal levels which lie between 22 mEq/L and 26 mEq/L (Balci et al., 2013).
What body system will attempt to compensate (and how will it compensate; what is retained if the body is too acidic)?
The process is known as metabolic compensation where the kidney conserves the bicarbonate ions with the aim of preventing the respiratory diseases that may create acidosis in the body. Through the metabolic processes, the kidney enhances the secretion of hydrogen ions (H+) and increasing the conservation of bicarbonate (HCO3) as well. The combination of the H+ AND HCO3 helps in neutralizing the acid in the body, and the combination is further converted into carbon dioxide which through hyperventilation gets expired quickly of the lungs.
Balci, A. K., Koksal, O., Kose, A., Armagan, E., Ozdemir, F., Inal, T., & Oner, N. (2013). General characteristics of patients with electrolyte imbalance admitted to emergency department. World Journal Of Emergency Medicine, 4(2), 113. doi: 10.5847/wjem.j.issn.1920-8642.2013.02.005
DiNicolantonio, J. J., O'Keefe, J. H., & Wilson, W. (2018). Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis. Open Heart, 5(1), e000668. doi: 10.1136/openhrt-2017-000668
Terker, A. S., Zhang, C., McCormick, J. A., Lazelle, R., Zhang, C., & Meermeier, N. et al. (2015). Potassium modulates electrolyte balance and blood pressure through effects on distal cell voltage and chloride. Cell Metabolism, 21(1), 39-50. doi: 10.1016/j.cmet.2014.12.006
Thomsen, R. W., Nicolaisen, S. K., Hasvold, P., GarciaSanchez, R., Pedersen, L., & Adelborg, K. et al. (2018). Elevated potassium levels in patients with congestive heart failure: Occurrence, risk factors, and clinical outcomes. Journal Of The American Heart Association, 7(11). doi: 10.1161/jaha.118.008912
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