University Nursing Assignment: Metabolic Acidosis Case Study Analysis

This nursing assignment analyzes a clinical scenario consistent with metabolic acidosis. The solution identifies key data supporting the diagnosis, including anion gap, shortness of breath, patient history of chronic kidney disease and diabetes, and electrolyte imbalances such as high creatinine and low CO2. The assignment explains the underlying causes of the acid-base disorder, such as high anion gap, kidney dysfunction, and increased hydrogen ion production. It also details the role of chemical buffer systems in maintaining pH balance and the effects of metabolic acidosis on calcium and potassium levels. The solution further discusses the need for monitoring metabolic acidosis due to its impact on cardiovascular function, immune system, and risk of cerebral edema. References from medical journals are included to support the analysis. This document provides a comprehensive understanding of metabolic acidosis from a nursing perspective.

Running Head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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Answer to question 1
The clinical scenario is most consistent with the metabolic acidosis. It is the condition of
the acid base balance where an excessive quantity of acid in blood is produced by the body.
Answer to question 2
The data in the clinical scenario that supports the diagnosis are (Jameson & Loscalzo,
2016) -
 Anion gap- 26 mEq/L- In healthy subjects the urine anion gap should be < 10
mEq/L. Higher gap of 26 mEq/L is evident of metabolic acidosis, which is the
dysfunction of kidney.
 Shortness of breathing
 Nausea and vomiting
 Patient history of chronic kidney disease and diabetes mellitus
 High creatinine
 Low CO2-10 mEq/L- TCO2 concentration is reduced in metabolic acidosis
 Hyperkalemia- potassium (6.0 mEq/L)
 Elevated BUN and creatinine level due to uncontrolled diabetes and is
represented in diabetic acidosis
Answer to question 3
Mr. X’s acid base disorder is due to-
 High anion gap caused by addition of acid

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 Kidneys when fail to excrete ammonia- rapid loss of renal function
 renal tubular acidosis
 Chronic kidney disease as in patient leads to uraemia
 Increased production of hydrogen ions- causing low blood pH (Brubaker &
Meseeha, 2017)
Answer to question 4
a)
Chemical buffer system helps to resist the body pH changes as a defense mechanism. The
buffer action refers to the resistance of the acid-base mixture to sudden pH changes.
The buffer system maintains the acid base homeostasis by releasing the hydrogen ions
during the increase of the pH. This system binds hydrogen ions when the pH decreases. The
mechanism occurs by three chemical buffer systems in the body and an extremely important role
is played by carbonic acid-bicarbonate buffer system which convert the strong base to weak base
and strong acid to weak acid (Kamel & Halperin, 2016).
b)
In chronic kidney disease, kidneys fail to excrete enough acid anions from the body. This
cidosis results in the high anion gap pH falls below 7.35. With the decrease in the functioning
nephrons, the increase in ammonia excreted per nephron maintains the acid secretion. Eventually
total ammonium excretion falls. Since, kidney tends to retain more hydrogen ions. In
extracellular fluid, the bicarbonate buffers the retained acid by tissue buffers. Since, Mr X. is

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undergoing dialysis, low plasma bicarbonate levels occurs and hence buffering is hampered
(Berend et al., 2014).
c)
In metabolic acidosis, the calcium ion levels are decreased. It is because of same binding
site of calcium and hydrogen in protein molecules. The binding being pH dependent calcium
homeostasis is altered (Relia & Batlle, 2016). Acidosis decreases the protein binding of calcium
to albumin.
d)
In metabolic acidosis, blood potassium is elevated as observed in Mr X. Potassium
homeostasis is altered by increase in acid concentration. During acidosis the potassium moves to
extracellular fluid in exchange for hydrogen ions, thereby altering its homeostasis ().
Answer to question 5
Metabolic acidosis needs to be monitored due to depressive impact on cardiovascular
function, suppression of immune system, seizures and shock. There is an increased risk of
cerebral edema during bicarbonate administration (Relia & Batlle, 2016).

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References
Berend, K., De Vries, A. P., & Gans, R. O. (2014). Physiological approach to assessment of
acid–base disturbances. New England Journal of Medicine, 371(15), 1434-1445.
Brubaker, R. H., & Meseeha, M. (2017). High Anion Gap Metabolic Acidosis.
Kamel, K. S., & Halperin, M. L. (2016). Fluid, Electrolyte and Acid-Base Physiology E-Book: A
Problem-Based Approach. Elsevier Health Sciences.
Relia, N., & Batlle, D. (2016). Pathophysiologic Approach to Metabolic Acidosis. In Metabolic
Acidosis (pp. 53-63). Springer New York.