A 50yearold man came to the emergency department after retur

A 50-year-old man came to the emergency department after returning from a foreign travel. His symptoms included persistent diarrhea (over the past 3 days_ and rapid respiration (tachypnea). Blood gases were drawn with the following results: pH 7.21 pCO2 19 mm Hg pO2 96 mm Hg HCO3 7 mmol/L SO2 96% (calculated) (reference range, >95%) 1. What is the patient’s acid-base status? 2. Why is the HCO3 level so low? 3. Why does the patient have rapid respiration? If the patient is suffering from one of the following conditions, what would you expect the following to be? Indicate increase, decrease, or normal after each lab test. Disorder Lab tests Renal Acidosis Anion gap BUN Creatinine Diarrhea Anion gap Chloride Lactic acidosis Anion gap Lactic acid Drug intoxication Drug screen

Solution

A) As pH level is 7.21 which is less than 7.35, it depicts the condition of metabolic acidosis. there must be high production of H⁺ in the body and kidney must not be forming enough of the Bicarbonate ions. now, because of the higher concentration of CO2 in blood and lower pH we can also called it as the condition of respiratory acidosis.

B) Diarrhoea must have caused the loss of the reserves of the HCO3- ions the body and kidney must not be forming enough of it

C)low blood pH --->high CO2 levels---> stimulates the respiratory center in the brain----> if the respiration is stimulated more amount of CO2 would be exhaled in order tp bring it back to the normal levels.

2) a) Anion gap is the difference in the concentration of the anions and cations in plasma, urine etc. An increased levels of anion gap is seesn in Renal acidosis and lactic acidosis. so, we can say that increased anions or acids causes increased anion gap.

It is characterized by lower bicarbonate concentration and increase in chloride concentration.

b) elevated BUN causes elevated Anion gap

C) Lactic acid drug intoxication also would increase the anion gap