NUR 631 Acid-Base Case Study  • Online Nursing Essays

Sample Answer for NUR 631 Acid-Base Case Study  Included After Question

Mr. Davis is 56-year-old male who has a past medical history of HTN (hypertension). Every Sunday, he goes to his favorite restaurant to watch sports with his friends. While making several trips to the restroom over in 1 hour, Mr. Davis complains of feeling tired and weak. He starts sweating profusely, his breathing becomes rapid and deep, his speech is slurred, and eventually he passes out. His friend’s call 911, and Mr. Davis is transported to the hospital. On admission to the hospital, Mr. Davis’s lab work shows the following values: 

 
Mr. Davis’s Values 
Normal Ranges 

Sodium (Na+) 
155.0 mEq/L 
 

Potassium (K+) 
6.2 mEq/L 
 

Chloride (Cl-) 
120.0 mEq/L 
 

Glucose 
52.0 mg/dL 
 

ABG pH  pCO2 HCO3 
 7.15 30 16 
 

UA Ketones  Protein 
 + + 
 

A Sample Answer For the Assignment: Acid-Base Case Study 
Title: Acid-Base Case Study 
PATIENT SCENARIO
Mr. Davis is 56-year-old male who has a past medical history of hypertension​
Every Sunday, he goes to his favorite restaurant to watch sports with his friends ​
While making several trips to the restroom in a 1-hour period, Mr. Davis complains of feeling tired and weak​
He starts sweating​
His breathing becomes rapid and deep​
His speech becomes slurred​
He passes out ​
His friends call 9-1-1, and Mr. Davis is transported to the hospital​

What type of Acid-Base Disturbance is Mr. Davis Suffering from?
 
EXCESSIVE ALCOHOL CONSUMPTION:​
METABOLIC ACIDOSIS
Alcoholic ketoacidosis- ketoacidosis without hyperglycemia. ​
Metabolism of alcohol impairs gluconeogenesis, paired with decreased protein and carbohydrate stores leads to hypoglycemia. ​
Metabolism of alcohol leads to formation of ketones such as acetoacetate, B-hydorxybutyric acid, or acetone. ​

METABOLIC ACID-BASE BUFFERS
RENAL​
-The renal system compensates by producing more acidic or more alkaline urine (hours to days) ​
-Correction occurs when the values for both components of the buffer pair ratio (bicarbonate and carbonic acid) return to normal. 
Urine Ketones
​Ketonuria is common when there is insufficient insulin. Ketones (acetone) are broken down and released into the blood, which causes metabolic acidosis​
Then diuresis transports into urine which can easily be detected.
Urine Protein
Increased glomerular membrane permeability ​
Results in serum protein loss​
Leads to renal injury 
Recommendations for treatment
Provide the patient with intravenous thiamine to prevent Wernicke’s encephalopathy or Korsakoff’s psychosis​
Dextrose: correct critically low glucose of 52 mg/dL; assess for effect on mental status ​
Fluid replacement: evaluate for urinary retention, insert Foley catheter as needed​
Respiratory support: NIVPPV as tolerated or intubation if airway protection is impaired or aspiration risk is high​
Electrolyte replacement ​
Frequent monitoring: mental status, vitals, central IV access, frequent blood work, repeat urine for protein in 8-12 hours, repeat urine for ketones 24hrs after acidemia correction​
Admission to ICU or Intermediate care ​
-when blood glucose is improved, consider administering IV dextrose and insulin for hyperkalemia, ​
-administer fluids while assessing for pulmonary edema and overload ​
Recommendations for treatment
 

References

Alabi, F., Alabi, C., Basso, R., Lakhdar, N., Oderinde, A. (2020). Multiple electrolyte imbalances and acid-base disorder posing a diagnostic dilemma: a case report. Journal of Medical Case Reports, 14:15. https://doi.org/10.1186/s13256-019-2330-2​

Baj, J., Flieger, W., Teresinski, G., Buszewicz, G., Sitarz, R., Forma, A., Karakula, K., Maciejewski, R. (2020). Magnesium, calcium, potassium, sodium, phosphorus, selenium, zinc, and chromium levels in alcohol use disorder: A review. Journal of Clinical Medicine, 9(6), 1901. https://doi.org/10.3390/jcm9061901​

Bashir, B., Fahmy, A. A., Raza, F., & Banerjee, M. (2021). Non-diabetic ketoacidosis: a case series and literature review. Postgraduate Medical Journal, 97(1152), 667- 671. https://doi.org/10.1136/postgradmedj-2020-138513​

Epstein,  M. (1997). Alcohol’s impact on kidney function. Alcohol Health and Research World, 21(1), 84-92. Retrieved on May 23, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826793/​

Long, B., Lentz, S., & Gottlieb, M. (2021). Alcoholic Ketoacidosis: Etiologies, Evaluation, and Management. Journal of Emergency Medicine, 61(6), 658–665. https://doi-org.lopes.idm.oclc.org/10.1016/j.jemermed.2021.09.007​

McCance, K. L., Huether, S. E., Brashers, V.L., & Rote, N.S. (2019). Pathophysiology the biological basis for disease in adults and children (8th ed.). Elsevier Health ​

Sciences. ISBN-13:9780323402811​

McGuire, L, Cruickshank, A., Munro, P. (2006). Alcoholic ketoacidosis. Emergency Medicine Journal 23(6), 417-420. https://doi.org/10.1136/emj.2004.017590​

Seifter, J. L., & Chang, H. Y. (2017). Disorders of Acid-Base Balance: New Perspectives. Kidney diseases (Basel, Switzerland), 2(4), 170–186. ​

https://doi.org/10.1159/000453028 ​