new_n_lost
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This question is really easy all u have to do is apply ur knowledge
A 65-year old male hospital in-patient has smoked cigarettes since he was 18 years old. He has a chronic cough and marked sputum production. When his doctor starts to give him the usual talk about losing weight, he explains that since he has about fifty pounds to lose, he has tried to exercise, but is unable to because of shortness of breath with any activity. Upon further questioning, he comments that his symptoms have been present for a very long time, but he was hospitalized due to a marked exacerbation of his complaints. On auscultation, rhonchi and wheezes are heard.His laboratory results are as follows:
- pCO2 60 mm Hg(35-45 mm Hg)
- pH 7.34( 7.35-7.45)
- bicarbonate 31 mEq/L( 24 mEq/L)
- Na+ 140 mEq/L( 135-145 mEq/L)
- K+ 4.0 mEq/L( 3.5-5.5 mEq/L)
- Cl-100 mEq/L(98-109 mEq/L)
What is the primary disorder?
a) metabolic acidosis with a normal anion gap
b) metabolic acidosis with an elevated anion gap
c) metabolic alkalosis
d) respiratory acidosis
e) respiratory alkalosis
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| me007
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d.
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| Diego Casali
Forum Elite
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Low pH and high PCO2 speak for respiratory acidosis.
This is chronic respiratory acidosis because bicarbonate level is higher than normal (renal compensation).
So, I agree with me007: the correct answer is D.
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| new_n_lost
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___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| mildus
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yes, D
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| new_n_lost
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Correct answer: D
EXPLANATION
This patient has symptoms and signs of chronic obstructive pulmonary disease, specifically chronic bronchitis.
Symptoms and signs include cough, sputum production and dyspnea with exertions. Patients tend to be stocky or overweight, as the case here.
Auscultation will reveal wheezes and rhonchi.This patient is retaining CO2, since his pCO2 is elevated. CO2 is in equilibrium with carbonic acid. An increase in CO2 will shift the Henderson Hasselbalch equation to the left, resulting in acidosis. Since the cause of the primary problem is respiratory, e.g. retention of CO2, this is a
respiratory acidosis.
This is reflected in the pH being reduced as well.Metabolic acidosis (choice a, choice b) is incorrect because the primary problem is not due to a administration of acid, excess metabolic acid formation, or loss of base. Although the bicarbonate level is abnormal in this patient, that is due to metabolic compensation for the respiratory acidosis.
Alkalosis (choice c, choice e) are incorrect because his pH is acidotic. Although compensatory mechanisms can bring the pH towards the normal range, compensatory mechanisms will never overshoot.
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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