Introduction
In this case, the patient is an 85-year-old female who complained of not breathing well for the past two days. During the examination, she was lethargic, and her skin was dry and warm. Another important observation is that the patient has decreased urine output.
A nurse orders some lab tests: while K and PO2 are within normal limits, the results reveal several abnormalities, including increased Na, Cl, PCO2, HCO3, urine specific gravity, and decreased pH. Identifying abnormalities is critical for predicting health problems that occur with time and helping the patient at the moment.
Identification of Abnormalities
Abnormalities in blood chemistries, arterial blood gases, and urinalysis indicate a health problem. A normal range of sodium is between 135 and 145, and the patient’s level is 147, which proves the first abnormality and indicates hypernatremia (Tauseef et al., 2021). This condition is associated with such symptoms as thirst and decreased urination and is common in the elderly population.
Sodium abnormality, as well as a high range of chloride, may provoke kidney problems. The patient’s level is 110, which exceeds the required limit between 95 and 105 (Breen et al., 2021). Urine-specific gravity abnormalities help detect kidney impairment when the results are higher than 1.030 or lower than 1.005 (Nainggolan et al., 2021).
Although not all blood gas tests show abnormalities, there are several critical points. pH is decreased by 7.33, with a normal range between 7.35 and 7.45 (Hopkins & Sanvictores, 2022). Increased PCO2 (48, with a normal range between 35 and 45) and HCO3 (27, with a normal range between 22 and 26) are observed (Hopkins & Sanvictores, 2022). Elevated PCO2 and HCO3 indicate metabolic changes and low pH proves acidosis in the patient.
Electrolyte Disturbance
Electrolyte disturbance is one of the major signs of kidney problems when the patient does not have enough fluids in the blood and urine. In this case, the patient has elevated levels of sodium (hypernatremia), chloride (hyperchloremia), and bicarbonate (metabolic alkalosis) (Armata, 2021). All these results cannot be ignored because dehydration provokes additional problems with the heart or the brain, and electrolyte disturbances may be fatal.
Clinical Manifestations of Electrolyte Abnormality
During the examination, several clinical manifestations were identified, including fatigue and difficulty breathing, reported by the patient, and dry skin due to fluid loss, noticed by a nurse. However, additional clinical manifestations of electrolyte abnormality are also expected. For example, the patient can experience muscle weakness and spasms if an abnormal level of phosphate is observed (Armata, 2021).
Calcium abnormalities provoke confusion and irritability, while sodium and potassium abnormalities are characterized by vomiting and diarrhea with time (Armata, 2021). Excessive thirst is also a critical manifestation of the patient’s electrolyte imbalance, which requires urgent help to compensate for fluid loss.
Clinical Manifestations of Increased Potassium Level
At the moment of the patient’s examination, her potassium level was 4.0, which is within normal levels. However, if an increase occurs, it will prove another electrolyte abnormality. In this case, the nurse would monitor several clinical manifestations, namely muscle weakness, cramps, or even paralysis, vomiting, nausea, and chest pain, to predict cardiac arrhythmias (Palmer et al., 2021). Another serious complication if the condition remains untreated includes heart failure, which may lead to human death.
Blood Gas Abnormality
In the patient, several blood gas abnormalities are observed, proving acid excess and metabolic problems with the lungs. A partial pressure carbon dioxide level is high (PCO2 is 48, with normal limits between 35 and 45), as well as the level of bicarbonate (HCO3 is 27 when a normal range is between 22 and 26 (Hopkins & Sanvictores, 2022).
Respiratory acidosis is a common condition for this blood gas abnormality because high PCO2 is a sign that the blood is acid. Her pH level is low (7.33) when the normal limits are between 7.33 and 7.45 (Hopkins & Sanvictores, 2022). It is also strong proof that the blood is acid, and the patient develops difficulty breathing and fatigue or may report headaches and confusion.
Mechanisms of pH Regulation
Acid-base balance is a critical requirement to treat metabolic acidosis in patients. The body has to regulate pH to maintain it between 7.35 and 7.45 (Quade et al., 2021). There are three major mechanisms of pH regulation, namely the urinary system, the neuro-respiratory system, and the buffer systems (Quade et al., 2021).
The urinary system controls the blood bicarbonate concentration, which is high in the chosen patient. The neuro-respiratory system is responsible for controlling the partial pressure of carbon dioxide, which is also high in woman. Finally, the buffer systems help maintain a normal pH level in the blood and predict fluid changes in the blood.
Conclusion
In general, the patient under examination has several critical symptoms, which prove her kidney problems and metabolic acidosis in particular. Most blood chemistries (Na and Cl) are high, and arterial blood gases are abnormal (pH, PCO2, and HCO3). The urine-specific gravity test is used to evaluate the body’s water balance when decreased urination is noticed. Its increased level proves that dehydration and complications with kidneys are a matter of time. The nurse needs to inform the doctor to define a specific course of treatment.
References
Armata, N. N. (2021). Electrolyte imbalances: What is it, causes, presentation, and more. Osmosis. Web.
Breen, T. J., Brueske, B., Sidhu, M. S., Kashani, K. B., Anavekar, N. S., Barsness, G. W., & Jentzer, J. C. (2021). Abnormal serum chloride is associated with increased mortality among unselected cardiac intensive care unit patients. PloS One, 16(4). Web.
Hopkins, E., & Sanvictores, T. (2022). Physiology, acid base balance. Statpearls. Web.
Nainggolan, G., Soemarko, D., Siregar, P., Lydia, A., Bardosono, S., Prijanti, A. R., & Aulia, D. (2021). Diagnostic role of urine specific gravity to detect kidney impairment on heat-exposed workers in a shoe factory in Indonesia: A cross-sectional study. BMJ Open, 11(9). Web.
Quade, B. N., Parker, M. D., & Occhipinti, R. (2021). The therapeutic importance of acid-base balance. Biochemical Pharmacology, 183. Web.
Palmer, B. F., Carrero, J. J., Clegg, D. J., Colbert, G. B., Emmett, M., Fishbane, S., Hain, D. J., Lerma, E., Onugbo, M., Rastogi, A., Roger, S. D., Spinowitz, B. S., & Weir, M. R. (2021). Clinical management of hyperkalemia. Mayo Clinic Proceedings, 96(3), 744-762. Web.
Tauseef, A., Zafar, M., Syed, E., Thirumalareddy, J., Sood, A., Lateef, N., & Mirza, M. (2021). Prognostic importance of deranged sodium level in critically ill patients: A systemic literature to review. Journal of Family Medicine and Primary Care, 10(7), 2477-2481. Web.