Assignment task: A 70 year old male with congestive heart failure secondary to hypertensive heart disease is maintained on Digoxin, Enalapril and Amlodipine. He consults his private physician for leg swelling and difficulty of breathing. He is prescribed oral furosemide tablets which reduces his shortness of breath and lessens his leg swelling. However he develops confusion, hand tremors and muscle cramps. On consult at the ER, his BP is 90/60, HR is 90/min., RR is 20/min. Usual body weight is 60 kg. He is drowsy. He complains of generalized weakness. You notice a few hand tremors. He has bibasal crackles and decreased breath sounds. He has soft heart sounds and an apical systolic murmur. Liver edge is palpable 1 inch below the right subcostal area. He has ankle edema. Muscle strength is Grade 3/5 over the examined extremities.
Laboratory examinations are as follows:
Serum: Na 128 meq/L , K 2.5 meq/L, Cl 86 meq/L
ABG: pH 7.41, paCO2 48 mmHg, HCO3 29 meq/L
BUN: 35 mg/dl
RBS: 200 mg/dl
Creat: 1.5 mg/dl
Q1. What clinical clues suggest the presence of an acid-base disorder?
Q2. What is/are the acid base disorders?
Q3. What is/are the etiologies of the identified acid/base disorders?
Q4. Explain the pathophysiology behind the acid-base disorder/s.