Respond/Answer the 3 questions following the case
Respond/Answer the 3 questions following the case study below: Situation: 57 year old male, presents to ED for increased weakness, decreased level of consciousness and agitation. Patient is unable to stand or ambulate. Patient’s abdomen is hard and distended, guards on assessment. Patient is poor health historian due to decreased level of consciousness but is able to respond to his name. Background: Patient is accompanied by his friend who states that patient was drinking heavily the past couple days following the recent passing of another good friend. Patient’s friend became concerned when patient could no longer stand up on his own and was complaining of numbness in both feet. Patient has a history of excessive alcohol use, unmanaged type 2 diabetes and is on medication for severe depression. The patient has now developed confusion, headache and is breathing rapid but deep breaths. He is feeling weak accompanied by nausea and vomiting after excessive alcohol consumption. Allergies: No known allergies. Medical history: Chronic alcohol use, hypertension, Type 2 diabetes, major depression. Home medications: Mirtazapine 7.5mg PO at bedtime, Duloxetine 30mg PO daily, Metoprolol tartrate 50mg PO daily, Metformin 500mg PO BID. Medications due today: Potassium IV bolus mixed with NaCl 0.9%. Assessment: Patient is lethargic with increased confusion, difficulty making his needs known and is not able to recall the events that led to his current state of health. Patient has noticeable weakness and is unable to self-transfer. Increased agitation noted during head to toe assessment, with one episode of combativeness when staff attempted to assess his abdomen. Airway is patent but noted heavy breathing with use of the accessory muscles. Rapid, irregular heart rate. +3 pitting edema noted to bilateral lower extremities and feet. Skin – pale, cold and clammy. Patient now has increased nausea and is vomiting multiple times an hour. He is sitting up taking fast deep breaths complaining that he needs air. PH: 7.0 PCO2: 37 HCO3: 19 Vital signs: Oral temp: 98.9F, Blood pressure: 89/64, HR 121 irregular; Respirations: 28, SPO2 92% room air. Labs: BMP Labs: Range: 12/30/2023: Today: Glucose 70-99 240(h) 334(h) Na+ 135-145 139 133 K+ 3.5-5.0 3.0(l) 2.0(l) Cl- 98-106 100 98 Ca 8.4-10.5 9.0 8.5 Mg 1.5-2.5 1.8 1.6 PO4 2.7-4.5 4.0 4.4 Hct 36-48% 38 35(l) Hgb 11.6-15 9(l) 8(l) Report / Recommendations (Questions to be ): What type of acid imbalance is the patient at risk for? What could have caused this? What buffer system will kick in to help balance the patient out? Citations; Brutsaert, E. F. (2023, January 31). Alcoholic ketoacidosis – endocrine and metabolic disorders. Merck Manuals Professional Edition. Retrieved February 6, 2023, from https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/alcoholic-ketoacidosis#:~:text=Alcohol%20diminishes%20hepatic%20gluconeogenesis%20and,Metabolic%20acidosis%20is%20primary%20reduction Metabolic acidosis: Causes, symptoms, diagnosis & treatment. Cleveland Clinic. (n.d.). Retrieved February 6, 2023, from https://my.clevelandclinic.org/health/diseases/24492-metabolic-acidosis
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