Last week's topic was fluid and electrolyte imbalances.

Now, in week 8, "Acid-Base Imbalance"

has been added to the discussion. Maintaining acid-base balance is fundamental for the normal
functioning of biological processes, mainly due to the pH dependence of enzyme function. This
insight reviews definitions of acid-base balance and describes the normal physiology of acid-
base metabolism in extracellular fluid and blood. The individual roles of the kidneys, liver,
bones, and lungs in maintaining acid-base balance are described in detail in Health and Disease.
The pathogenesis of common conditions (diabetes, renal failure, drug intoxication) affecting
acid-base balance was evaluated as well as potential therapeutic strategies. The impact of food
intake on acid-base status is also discussed. An imbalance in blood pH can lead to two
conditions: acidosis and alkalosis. Acidosis is the blood that is too acidic or blood pH below
7.35. Alkalosis refers to the blood being too basic or the blood pH above 7.45. Therefore, it is
advisable to take care of the balance of the body. An individual's body homeostasis must be
maintained for the body to function properly, which inevitably leads to effective health.

ELECTROLYTE IMBALANCES.

Several patients were admitted in the medical ward. Answer the following questions pertinent to
the patients’ conditions.
PATIENT A – Presented in the emergency department with severe headache, irritability, and
tremors after finishing a full marathon. Laboratory values reveal serum sodium level of 130
mEq/L.
PATIENT B – Presented in the emergency department with severe body malaise, diminished
bowel sounds, and ECG reveals an extra U-wave in the tracing after 8 bouts of watery diarrhea.
Laboratory values further reveal a s erum potassium level of 3.0 mEq/L.
PATIENT C– A post thyroidectomy patient presented with severe muscle cramps and
prolongation of QT-interval in the ECG and was referred to the medical consultant for co
management. Serum calcium level is 4.0 mEq/L.
PATIENT D – A patient receiving magnesium for the management of seizure disorder suddenly
presented with depressed deep tendon reflex and becomes stuporous. Laboratory values reveal a
serum magnesium level of 2.6 mg/dL.
1. Given the Patient B’s presentation, trace the pathophysiological cause of the decrease in
serum potassium level.
▪ Potassium, the most abundant intracellular cation, is essential for the life of an
organism. Potassium homeostasis is integral to normal cellular function, and is tightly regulated
by specific ion-exchange pumps, primarily by cellular, membrane-bound, sodium-potassium
adenosine triphosphates (ATPase) pumps. Most important site of regulation is the renal
collecting duct, where aldosterone receptors are present.
2. What will be the emergency medication that should be readily available in managing the
disorder apparent for Patient D?
▪ Buccal (oromucosal) midazolam- is given into the buccal cavity.
3. Explain the relationship of thyroid surgery and the development of hypocalcemia in
Patient C.
▪ Hypocalcemia is a serious post-operative complication following complete
thyroidectomy that causes severe symptoms and prolong hospitalization. The major cause is
secondary hypothyroidism caused by surgical injury or devascularization of one or more
parathyroid glands.

4. Explain the relationship of Patient A’s prior activity and the development of
hyponatremia.
▪ Although exceedingly rare, this illness has resulted in death during or after lengthy runs
or marathons. Many runners are unduly worried with hyponatremia and fail to drink enough
fluids before, during, and after a lengthy run. After running a marathon, a significant number of
runners have unusually low blood sodium concentrations. The single most important component
related with hyponatremia is excessive fluid consumption, as shown by significant weight gain
during running.
5. Explain the mechanism behind the development of prolonged QT – interval for Patient
C.
▪ The mechanism of drug-induced prolonged QT interval involves inhibition of the rapid
component of the delayed rectifier potassium current (IKr). Blocking IKr leads to prolongation
of the ventricular action potential duration, leading to an excess sodium influx or a decreased
potassium efflux.
6. Enumerate at least one (1) nursing diagnosis for Patient A, B, C, and D.
Patient A- Hyponatremia
Patient B- Hypokalemia
Patient C- Long QT Syndrome
Patient D- Seizure Disorder

ACID-BASE IMBALANCES
Multitude of patient’s conditions can predispose them to different acid-base imbalances. Several
patients were admitted in the medical-surgical ward and are put under your care. Answer the
following questions pertinent to the patients’ conditions.
PATIENT A – Admitted in the medical ward 30 minutes ago with chief complaint of severe
dizziness and vertigo accompanied by frequent vomiting. As the patient moves, vomiting follows
which is now recorded to be 7-8 times from the time of admission. Diphenhydramine 1 ampule
TIV and metoclopramide 1 ampule TIV as stat doses were given to the patient.
PATIENT B – A dialysis patient who have stopped attending his dialysis session was admitted
in the ward due to changes in sensorium. Serum creatinine level is elevated as well as the Blood
Urea Nitrogen (BUN). Shallow respiration is noted upon the assessment of the patient.
PATIENT C - A patient was rushed to the emergency department and later was admitted to the
ward with chief complaint of shortness of breath, numbness and tingling around mouth and
fingers, and lightheadedness after taking a major examination in school. The patient was offered
a brown bag by the admitting nurse.
PATIENT D – A patient with emphysema as admitted in the ward due to difficulty of breathing.
The patient appears reddish and is complaining of lightheadedness. The patient was immediately
hooked to oxygen therapy at 2 lpm. Choose from the following ABG results which will be
consistent with the patient’s condition:
A. pH 7.50 PaC02 31 HCO3 17
B. pH 7.30 PaC02 30 HCO3 18
C. pH 7.48 PaC02 49HCO3 30
D. pH 7.32 PaC02 50 HCO3 28
1. Patient A: D
2. Patient B: C
3. Patient C: B
4. Patient D: A
5. Explain why Patient B presented with shallow respiration in relation to the patient’s
condition.
▪ Shallow breathing is a feature of or a symptom of a number of illnesses. Among the
most frequent are anxiety disorders, asthma, hyperventilation, pneumonia, pulmonary edema,
and shock. Shallow breathing is frequently accompanied with anxiety, stress, and panic attacks.
6. Explain why Patient D experiences lightheadedness and why the patient appears reddish
in relation to the patient’s condition.
 ▪ That might be an indication of COPD. When your lungs do not function correctly, you
do not obtain enough oxygen when sleeping, and carbon dioxide accumulates in your blood. A
sense of lightheadedness or dizziness upon awakening might potentially be an indication of
COPD.
7. Explain the purpose of offering brown bag to Patient C as an emergency management
for the patient’s condition.
▪ When you lose a substantial amount of CO2 as a result of hyperventilation, your body's
tissues might begin to fail. The rationale behind breathing into a paper bag is that rebreathing
exhaled air assists your body in reintroducing CO2 into your bloodstream.
8. Create a drug study for the medication: METOCLOPROMIDE specifying the following:
DRUG ACTION INDICATION CONTRA- ADVERSE NURSING
INDICATION EFFECT CONSIDERATION
Name: Blocks To prevent Contraindicated to Restleness. -Tell to the patient to
METOCLOPROMID dopamine chemotherapy hypersensitivity to drug, Fatigue. take 30 minutes before
E receptors by induced GI obstruction and Nausea. meals.
Brand Name: disrupting CNS vomiting. history of seizure Constipation - Instruct the patient to
Maxolon chemoreceptor disorder. Diarrhea. report involuntary
Dosage: trigger zone, movements of face,
5mg/ml increasing eyes, or limbs; muscle
Frequency: peristalsis and rigidity; altered
1- 2 hours. promoting consciousness;
Route: gastric excessive sweating.
Intravenous emptying.