An 82-year-old woman, Emma, is brought to the Emergency Department…
An 82-year-old woman, Emma, is brought to the Emergency Department…
An 82-year-old woman, Emma, is brought to the Emergency Department by her husband. He tells you for the past two days, Emma has had trouble staying awake and she seemed to be breathing fast. He also tells you she will barely eat or drink anything even though she says she is thirsty, and he noticed she has not been using the bathroom.
During your initial assessment, you find Emma to be arousable, but lethargic and her skin is warm and dry. She is tachypneic. Emma does not have a history of diabetes mellitus and she is not an alcoholic. Emma’s husband explains to you the rheumatoid arthritis in Emma’s hands flared up four days ago, so she was taking four Norgesic Forte pills every four hours instead of one pill every eight hours which is what her physician prescribed.
The ED physician orders labs and an arterial blood gas (ABG) test. These are the results:
Chemistry Findings:
Na 158 Cl 110 K+ 3.8 Albumin 5.4 Urinalysis: Urine Specific Gravity 1.042 Glucose: Neg Ketones: +2 Albumin: Neg RBC: Neg WBC: Neg |
Arterial Blood Gas:
pH 7.48 PaCO2 34 HCO3- 22 PaO2 94 |
Vital Signs:
B/P: 164/102 HR: 128 NSR RR: 32 Deep & Labored Temp: 100.8° F
|
Interpret Emma’s Lab Test Results
- Evaluate and explain the specific electrolyte disorders(s) Emma’s lab results reveal.
- What do you suspect is the etiology of Emma’s current condition?
Interpret the ABG results
- Determine the abnormalities in Emma’s ABG. Provide a rationale for each result. Is there compensatory mechanism involvement? Please explain.
- What clinical manifestations would you expect to see with this electrolyte imbalance?
- Discuss the role of the respiratory control mechanisms and the renal control mechanisms in maintaining acid-base balance.
- Calculate the patient’s anion gap. Please explain if it is decreased, increased, or normal and why. Provide a rationale for your response.