University Case Study: Metabolic Acidosis Diagnosis and Treatment Plan

This case study focuses on a 74-year-old woman named Alisa, admitted with hyponatremia and suspected metabolic acidosis. The analysis examines her blood pH (7.3), HCO3- levels (19.4), PaCO2 (21), and serum ion gap (27.6 mEq/L), indicating a high probability of metabolic acidosis. The study highlights the role of the respiratory and renal systems in maintaining pH balance and discusses the significance of arterial blood gas analysis. It identifies potential causes like high lactate levels and medication use (metformin), leading to a diagnosis of metabolic acidosis. The rationale for treatment involves immediate oral sodium bicarbonate administration, supported by references to relevant scientific literature. The case underscores the importance of understanding metabolic acidosis and its management through a comprehensive assessment of patient data and evidence-based treatment strategies.

Running head: METABOLIC ACIDOSIS
METABOLIC ACIDOSIS
Name of the Student:
Name of the University:
Authors note:

1METABOLIC ACIDOSIS
Metabolic acidosis is a medical condition in which there the high concentration or quantity of
acid observed in the blood. Alisa is 74 year old women who had been admitted and has fallen in
the risk of Hyponatremia. In Alisa’s case it has been Hyponatremia can be caused due to several
reasons and one of the reason could be metabolic acidosis, apart from liver damage and heart
failure. There has been anomalies of the kidney and urinary bladder related malignancies with
metabolic acidosis, and the urinary problems have diverse metabolic complications (Vasdev,
Moon & Thorpe 2013). The sodium or Na levels in the blood of the patient is below the normal
range of 115 mmol/L, this can further lead to neurological abnormalities, however, in Alice’s
case it is above the normal range. The pH plays an important in determine the pathogenesis of
metabolic acidosis in Alice’s case. In Alice’s report observed pH is 7.3, which means there is
high level of acidity in the blood. According to Sweitach et al. (2014), the ion sensitivity (H+-
ions) leads Ph sensitivity in the cellular behavior in case of metabolic disorders like cancer and
other kinds of metabolic disorders. The two systems in the body are responsible for maintaining
Ph levels of the blood 1) The respiratory system and another one is 2) Renal system. For
maintaining the homeostasis of the patient’s blood or maintaining the overall bodily function it is
important, for that to investigate, it is important to analyze arterial blood gases in the body in
Alice’s case. From reports it could be found that Alice has HCO3- <22 (base excess <-2), that
she has around 19.4, and that is below marginal level of metabolic acidosis. Therefore, the
patient has high probability of Metabolic acidosis.
It has been observed that Alice has PaCO2 as 21 which is again a sign of respiratory acidosis.
There is an observable serum iron gap which is 27.6 mEq/L{ ([Na+] + [K+]) − ([Cl−] + [HCO−
3]) = 27.6 mEq/L}, this data assessment in Alice’ case shows high serum ion gap which is
another contributing factor towards the indication of metabolic acidosis. High ion gap is the

2METABOLIC ACIDOSIS
result of high blood sugar resulting ketoacidosis and high levels of concentration of lactate in the
blood. There are observable high lactate levels in blood which is more than 3mmol/L, whereas
the normal level of the calcium lactate in the blood should be 0.5-1 mmol/L. There is a strong
evidence of association between increase in anion gap and lactic acidosis and lowering of pH
below 7.35, this acts the base of all acid base disorder especially has been observed (Kraut and
Madias 2014). In current scientific research it has been evident that in taking of medicines like
metformin increase the risk of metabolic acidosis as well as lactic acidosis in patient (DeFronzo
et al 2016). In Alice’s case this has been relevantly observed therefore, from the assessment, the
rationale is that Alice should be put on oral sodium bi carbonate administration immediately
(Gorava et al 2014).

3METABOLIC ACIDOSIS
References
DeFronzo, R., Fleming, G.A., Chen, K. and Bicsak, T.A., 2016. Metformin-associated lactic
acidosis: Current perspectives on causes and risk. Metabolism, 65(2), pp.20-29.
Goraya, N., Simoni, J., Jo, C.H. and Wesson, D.E., 2014. Treatment of metabolic acidosis in
patients with stage 3 chronic kidney disease with fruits and vegetables or oral bicarbonate
reduces urine angiotensinogen and preserves glomerular filtration rate. Kidney international,
86(5), pp.1031-1038.
Kraut, J.A. and Madias, N.E., 2014. Lactic acidosis. New England Journal of Medicine, 371(24),
pp.2309-2319.
Swietach, P., Vaughan-Jones, R.D., Harris, A.L. and Hulikova, A., 2014. The chemistry,
physiology and pathology of pH in cancer. Philosophical Transactions of the Royal Society B:
Biological Sciences, 369(1638), p.20130099.
Vasdev, N., Moon, A. and Thorpe, A.C., 2013. Metabolic complications of urinary intestinal
diversion. Indian journal of urology: IJU: journal of the Urological Society of India, 29(4),
p.310.