Case Study 1 Metabolic Acidosis

Vida Kwofie

Coppin State University

Family Nurse Practioner Program

Nursing 610- Pathophisiolgy

Instructor: Dr. Warren-Dorsey

10/10/13

Case Study 1 Metabolic Acidosis

Identification of the condition
Based on this laboratory analysis: Na =145, K=5, Cl=114, PH=7.2, HCO3=9,
CO2=22. Urinalysis notes calcium oxalate crystals. The appropriate condition for this
client is Metabolic acidosis. The CO2 level is decreased in this mechanism in order to
compensate for the acidotic state. (McCance, K. L. 2010). The unconscious state of the
client is due to the high acidic condition. According to McCance, K et al, a client in the
state of metabolic acidosis experiences symptoms ranging from lethargy, headache and
this can progress into coma if the acidotic condition increases (McCance, K. L. 2010).
The formation of calcium oxalate crystals in the urine can be caused by hypercalcemia
and this indicate the formation of kidney stones (McCance, K. L. 2010).
The laboratory analysis that provided the basis for the selection
The laboratory analysis that provided the bases for the selection above is the PH
level of 7.2 and HCO3 level of 9mEq/L.
The University of Minnesota laboratory reference guide indicates normal
bicarbonate (HCO3) level of 22-26mEq/L normal PH level of 7.35-7.45 (University of
Minnesota, 2005). The HCO3 level indicated for the client above is 9mEq/L which falls
below the expected normal range. Low HCO3 level indicate a metabolic condition and a
low PH indicates an acidic condition. (McCance, K. L. 2010).
According to the university of Minnesota laboratory reference guide, normal
sodium (Na)=137-145mEq/L, Potassium (K) = 3.6-5.0mEq/L) and Chlorine (CL) 98110mEq/L. The Na level for this client is 145mEq/L which falls within the normal range.
The K level of 5.0mEq/L also falls within the normal range. The CL level of 114mEq/L is
above the normal range.

Case Study 1 Metabolic Acidosis

Pertinent clinical and laboratory findings

This client chlorine level is above the normal range. According to McCance, K. L.
et al (2010), chlorine combines with other chemicals that form very toxic byproducts and
this can lead to cell death. When chlorine ion (CL-) combines with hydrogen ion (H+), it
forms hydrochloric acid (HCL) and this can also contribute to the metabolic acidotic state
of this client.
The presence of calcium oxalate crystals in urine can also be an indication of
kidney stones. According to a toxicology study by McMartin, K. et al, the buildup of
calcium oxalate crystals in the bladder can lead to kidney tissue death and this will
subsequently lead to renal failure.
According to McCance, K. L. et al (2010), early signs of metabolic acidosis
include lethargy and if untreated, can lead to coma. The unconscious state of the client is
due to the severity of the metabolic acidosis.
Rationale for the selection
Metabolic acidosis was selected because for a mechanism to acidosis, the PH
needs to be below 7.35 mEq/L. The client PH is 7.2 mEq/L which is below the normal
range. The condition is metabolic in that the HCO3 of 9 mEq/L falls below the normal
range. The low bicarbonate level is an indication of a metabolic condition (McCance, K.
L. 2010). The mechanism is compensating by the decrease amount of CO2 in order to
accommodate the acidotic condition.
Rationale for not selecting the other acid base mechanisms

Case Study 1 Metabolic Acidosis

The other acid-base abnormalities were not selected because, in order for a
condition to be respiratory acidosis, the PH should be below the normal range and CO2
should be high. The CO2 in this client case is low.
Metabolic alkalosis was not selected because in order for a mechanism to be
alkalosis, the PH has to be above 7.45 mEq/L. This client PH of 7.2 mEq/L is below the
normal range.
Respiratory alkalosis was not selected because in order for a mechanism to be
alkalosis, the PH needs to be above 7.45 mEq/L. This client PH is 7.2 mEq/L, which is
below the normal reference range.

Case Study 1 Metabolic Acidosis

References
University of Minnesota (2005). Normal Lab Value. Retrieved October 9, 2013 from
http://www.student.med.umn.edu/wardmanual/normallabs.php
McCance, K. L., Huether, S. E., Brashers, V. L., Rote, N. S. (2010). Pathophysiology:
The biologic basis for disease in adults and children. Mosby Elsevier. Maryland
Heights: MO.
McMartin, K. (n,d). Are calcium oxalate crystals involved in the mechanism of acute
renal failure in ethylene glycol poisoning? Clinical Toxicology, 47(9), 859-869.