A febrile 84-year-old female is brought from a nursing home to the emergency department. She is very cachectic and confu
Posted: Mon Jan 24, 2022 9:16 am
A febrile 84-year-old female is brought from a nursing
home to the emergency department. She is very cachectic and
confused, and has sagging skin folds and extremely dry
skin.
Admission serum lab results are as
follows:
Sodium = 168 mEq/L; Potassium = 6.2 mEq/L; Chloride =
130 mEq/L; Bicarbonate = 26 mEq/L; Osmolality = 360 mOSm/kg; and
urea-N = 38 mg/dl.
Her Hct = 58%
Questions
1. Explain the elevated sodium, potassium, chloride,
urea-N, osmolality, and hematocrit. 2. Why was the bicarb not
increased?
3. What other lab tests should be
obtained?
4. How might this situation have
occurred?
Case 2
A 14-year-old male was severely injured in a car
accident. He was hospitalized and required the use of a ventilator
during the acute phase of his illness. When he appeared to be
recovering, he was weaned off the ventilator with no apparent ill
effects. Analysis of his blood at that time showed the following
results:
Arterial blood:
pH = 7.32 pO2 = 52 mmHg pCO2 = 70
mmHg
bicarb = 35 mMol/L Chloride = 90 mMol/L Sodium = 136
mMol/L K = 4.5 mMol/L Questions
1. What is the type of acid-base balance
disorder?
2. What is its cause in this case?
3. Is there evidence for compensation in this
case?
4. Why is the serum chloride decreased?
home to the emergency department. She is very cachectic and
confused, and has sagging skin folds and extremely dry
skin.
Admission serum lab results are as
follows:
Sodium = 168 mEq/L; Potassium = 6.2 mEq/L; Chloride =
130 mEq/L; Bicarbonate = 26 mEq/L; Osmolality = 360 mOSm/kg; and
urea-N = 38 mg/dl.
Her Hct = 58%
Questions
1. Explain the elevated sodium, potassium, chloride,
urea-N, osmolality, and hematocrit. 2. Why was the bicarb not
increased?
3. What other lab tests should be
obtained?
4. How might this situation have
occurred?
Case 2
A 14-year-old male was severely injured in a car
accident. He was hospitalized and required the use of a ventilator
during the acute phase of his illness. When he appeared to be
recovering, he was weaned off the ventilator with no apparent ill
effects. Analysis of his blood at that time showed the following
results:
Arterial blood:
pH = 7.32 pO2 = 52 mmHg pCO2 = 70
mmHg
bicarb = 35 mMol/L Chloride = 90 mMol/L Sodium = 136
mMol/L K = 4.5 mMol/L Questions
1. What is the type of acid-base balance
disorder?
2. What is its cause in this case?
3. Is there evidence for compensation in this
case?
4. Why is the serum chloride decreased?