Case Study: Acid-Base Imbalance in a Patient with Respiratory and Metabolic Acidosis

Student Case Study
Student Name:
Patient Physical Details and Vitals
Gender: F Age: 25 Body Weight (Kg): Height (M):
Heart Rate: BP: Temperature(C0): Resp. Rate:
Patient Clinical Details
Main Complaint/
Symptoms:
Fatigue, shortness of breath, sleepiness, constant loss of consciousness,
vomiting, diarrhoea.
Physical Exam
Results:
Coughing, increased heart rate, weakness, nausea
Review of
Systems/Relevant
History:
The patient’s health records show a history of arrhythmia and seizures.
Diagnostic Samples and Imaging
 Blood
 Faeces
 Urine
 Sputum

Swab

Fluids
 Tissue
 Cytology
 Other, namely:
Tests / Profiles Requested
Biochemistry Haematology Microbiology Histology/Cytology
Blood pH to be
determined.
CO2 partial
pressure and
HCO3- tests.
arterial gas tests
Chest X ray
Metabolic panel
Indicates whether blood is in
acidosis normal range or in
alkalosis state.
Indicate whether the
imbalance is respiratory or
metabolic.
Urgency:  Normal Sample taken from patient:
  URGENT Date: 12/4/2018 (dd/mm/yyyy)
Time: 11.00 am (hh/mm)
  Fasting  Non-fasting

Other Relevant Clinical Information
Drug therapy: Aspirins Last
dose:
Day before
Date: 11/4/2018 (dd/mm/yyyy)
Time: 15.30 (hh/mm)
Other relevant
clinical
information:
Notable Initial Test Results (and Reference Range)
Blood pH 7 and presence of carbonic acid detected in the blood.
Low bicarbonate levels.
High HCO3-. 47mmHg
Plasma electrolyte picture
Na- 140 mmol/ L (132 -144)
K 2.9 mmol/ l (3.2 -4.8)
HCO3 27 mmol/ L (23-33)
Urea 10.5 mmol/ L (30-8.0)
Creat 0.14mmol/ L (0.06 -0.12)
AGap 33 mEq/L (7 -17)
Further Testing Details (if required)
Urine tests show high H+
Blood evaluations: analytes (pH, PC02, HCO3-)
the pH reference range: pH.7.45 alkalaemia
H+ (<35 nmol/ L) – alkalaemia
H+ (>45nmol/ L) – academia
High PC02 > (45mmHG) – respiratory acidosis
Low PC02 (< 35mmHg) – respiratory acidosis
High bicarbonate (> 33mmol/L) – Metabolic alkalosis
low level ( < 22 mmol/ L) – Metabolic Acidosis
Further Testing Results (if required)
Pathophysiology
A person’s blood needs the right balance of acidic and basic compounds to function
properly so as to achieve the required acid-base balance. The kidney and lungs are
responsible in maintaining the balance. Patient’s tests show a pH below 7.35 and therefore
exhibiting, physiological acidosis. Patients also experiences headaches, confusion and
fatigue which are direct symptoms of acid imbalance. She lacks numbness, tingling