Introduction
Body fluids are made to be balanced to enable sustainable and healthy functioning where disorders and diseases are prevented. The blood should have adequate basic (alkaline) and acid compounds to facilitate normal functioning of the body. The acid-base balance is kept by lungs and kidneys where slight variations on the balance can have significant effects on the body functioning and the internal organs. The balance can be affected by other imposed processes like hemodialysis that creates imbalances in the compounds. Increase or decrease in pH caused by the changes in alkalizes and basics can result in diverse body malfunctions that can be fatal if not handled.
A 22-year old patient had flu within 8 days that led to her acid-base balance being disturbed. The patient was exposed to fluid imbalance due to vomiting several times a day. Also she could not keep food down or liquids in the digestive season. The patient seems not to have sought a physician’s advice on the medication as she overdosed her body with antacids that changed the balance.
Classification of the Patient’s Acid-base Disturbance
The patient represented the below acid-balance values against the normal ranges.
|
Test Result |
Normal levels |
|
|
PH 7.5 |
7.35 – 7.45 |
|
|
PaCO2 40 mm |
Hg 35-45 mm Hg |
|
|
PaO2 95 mm |
Hg 80-100 mm Hg |
|
|
SaO2 97% |
95-100% |
|
|
HCO3- 32 meq/liter |
22-26 meq/liter |
Her PH was above the recommended, indicating alkalosis (excess PH above 7.5). Respiratory alkalosis can be attributed to lung problems, together with flu and other problems affecting the respiratory system. Her PH is above the norm as indicated; thus, she could have Alkalemia. It is also indicated by her serum pH, which seems to be over 7.5. The patient seems to have metabolic alkalosis where her HCO3- composition is above the norm at 32mEq/L. Metabolic alkalosis occurs when the amounts of the carbonic anions are above the recommended levels. However, her levels of PaCo2, SaO2, and PaO2 are within the acceptable limits (Pietrangelo, 2013). Thus, the patient can have metabolic alkalosis.
Factors Causing the Acid-base Disturbance (Metabolic Alkalosis)
The patient is not recorded taking fluids; and the one taken was excreted or vomited as the vomiting was severe. Metabolic alkalosis is caused by decreased acid production, increased renal acid excretion, increased renal and GI (gastrointestinal) HCO3- retention. Under such conditions, anions (-) exceed the cations (+), hence creating an imbalance. The patient was complaining of flu; therefore, her lung ventilation could be jeopardized, thus affecting minute ventilation. The changes in the PH could be attributed to many factors; thus, metabolic alkalosis could lead to more deteriorating alkalosis (Kaplan & Kellum, 2004).
Compensation Mechanisms by the Respiratory and Renal Systems
The metabolic alkalosis should be compensated by having a primary increase in HCO3 and a compensatory increase in PaCO2 to balance the increasing alkalinity of the body fluids. It is expected that 0.6-0.75 mm Hg increase in PCO2 with every 1 mmol/L increase of HCO3- with limits put for PCO2 at 55 mm Hg in compensation. Hypoventilation has also been suggested to respond to metabolic alkalosis well where it causes an increase in arterial pCO2 that translates to increased acidity countering the soaring alkalosis. Hyperventilation can be castigated by pain, pulmonary congestion, and hypoxaemia where the peripheral chemoreceptors can be stimulated, thus increasing pCO2. It happens when arterial pO2 is lower than 50 to 55 mm Hg (Brandis, n.d.).
Pharmacological Intervention for Acid-base Disturbance
The patient needs to be treated since the cause can be controlled. She can be given IV 0.9% of saline solution to initiate Cl-responsive metabolic alkalosis. Since hypokalemia and hypovolemia are prevalent, they are treated. The IV saline solution should be between 50-100mL/h and it should be greater than urinary and other body fluids, both insensible and sensible losses. Severe metabolic alkalosis which PH is above 7.6 should undergo urgent correction of serum PH. The situation can be corrected by hemodialysis and hemofiltration, especially when the condition is faced with renal dysfunction and volume overload. Medications like Acetazolamide can be administered to control losses of K+ and PO4- ions. The balance of the ions should bring back the acid-base balance (Lewis, 2013).
Educational Needs for the Patient and Approach to Use
The patient needs to be educated about the causes of PH imbalance and the consequences of it. The approach to be used is to assemble the patient and her caregivers, explaining how the situation comes in and how it can be rectified and maintained. The patient can be presented with her lab results showing the anions and cations balance. Since it shows the normal ranges, it would be easier to explain to her that her condition is metabolic alkalosis. It is caused by reduced acidity and increased anions in the body fluids (Lewis, 2013). It is advisable to present extreme conditions like acidemia and alkalemia that affect cardiac and pulmonary functioning. She should also be warned that alkali administration, the anti-acids she has been taking, have increased her alkali levels, leading to metabolic alkalosis. She needs to know how to control fluid loss to avoid the loss of electrolyte which in turn causes the disorder.
