Thursday, October 4, 2012

Hypothetically with knowing how to identify one who is having a acid-base deficit could I diagnosis someone

Hypothetically with knowing how to identify one who is having a acid-base deficit could I diagnosis someone?
I was recently taught in the nursing program about acid and bases in my pathophysiology class and now just finished the course. If for example a patient comes into ER with symptoms of feeling fatigue and having a distinguish fruity smell from their breath. I suspect ketoneacidosis and that he/she may have type 1 diabetes mellitus. With getting the lab values back from the lab I see that his/her blood serum ph is 7.45 , PCO is 30mmHg and the HCO is 28mmHg. With knowing this I see that the patient is experiencing Respiratory Alkaline with a complete metabolic compensate. I this a possible diagnosis or even a proper one? With this knowledge of being able to figure out someone who is with such symptoms and then seeing on their lab values and such and making a diagnosis is possible? I know I can't really make a diagnoses and that only can a physician do so, but I was just wondering out of curiosity? Thanks! note: HCO is 20mmHg not 28mmHg
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A patient with the fruity smell on their breath is going to be a Diabetic Ketoacidosis patient, Acidosis being the key factor there. They breathe fast in order to blow off the carbon dioxide which is causing the acidosis. I think that a PH of 7.45 is very unlikely in this situation. The diagnosis should be Comensated metabolic alkylosis. Normal lab values for HCO is 22-26, so that is elevated and causing the high end of normal on the PH. The PCO normal range is 35-45, it is decreased to compensate for the high bicarb. Bottom line, the Bicarb value is high. The respiratory factor PCO is low to compensate for the high bicarb. Hope this helps!

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