# The Type of the Acid-Base Disturbance

## Introduction

Acidbase disturbances or imbalances can be discussed as a result of a change in value of the pH or the hydrogen ion concentration. In a restaurant, Mr. Davis feel tired and then passed out while demonstrating the signs of the acid-base disturbance. The man’s weakness was associated with sweating and breathing deep and rapidly. This paper aims to determine the type of the acid-base disturbance in Mr. Davis with the focus on analyzing his values and determining the possible causes of the problem depending on the case.

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## Mr. Davis’s Values

The examination of Mr. Davis’s state should be based on the discussion of his values received as a result of the laboratory analysis and comparison to the normal values. The values are presented in Table 1.

Table 1. Normal Values

 Normal Range Mr. Davis’s Values Sodium (Na+) 142.0 mEq/L 135.0-145.0 mEq/L 155.0 mEq/L Potassium (K+) 4.0 mEq/L 3.8-5.0 mEq/L 6.2 mEq/L Chloride (Cl-) 103.0 mEq/L 97.0-107.0 mEq/L 120.0 mEq/L Glucose 100.0 mg/dL 80.0-120.0 mg/dL 52.0 mg/dL ABG pH 7.40 7.35 to 7.45 7.15 pCO2 40 mEq/L 35 to 45 mEq/L 30 mEq/L HCO3 24 mEq/L 22 to 26 mEq/L 16 mEq/L UA Ketones – – + Protein – – +

## Acid-Base Disturbance in Mr. Davis

In order to determine the type of the acid-base imbalance, it is necessary to analyze the level of pH first. The pH is 7.15, lower than the normal value (7.35). This fact indicates the presence of the acidemia or acidosis. In Mr. Davis, the primary problem or the cause of the acidemia is the metabolic disturbance because the HCO3 is 16 mEq/L, less than 22 mEq/L. This value is typical for the metabolic acidosis. The examination of the pCO2 that is also less than 35 mEq/L supports the conclusion about the metabolic acidosis as the primary acid-base imbalance in Mr. Davis because the direction of the abnormal change in parameters is the same. It is typical for the metabolic acidosis when HCO3 and pCO2 are lower than the norm (McCance & Huether, 2014, p. 127). Moreover, in case of Mr. Davis, the decrease in the pCO2 is the compensatory response.

## Role of the Alcohol Consumption

One of the causes of the metabolic acidosis that is not associated with kidney diseases is the alcohol consumption during a long period of time. In case of Mr. Davis, the regular and excessive alcohol use could provoke the acute acid-base disturbance such as the metabolic acidosis because of intoxication of the organism. Ethanol often causes the metabolic acidosis and the very high anion gap. The fact that Mr. Davis felt tired and passed out in the restaurant supports the idea that the excessive alcohol use could lead to changes in the acid balances.

## Electrolyte Imbalances Associated with Mr. Davis’s Case

The past history of hypertension in Mr. Davis indicates that he can have significant problems with the electrolyte balance. Furthermore, the excessive consumption of alcohol can also cause electrolyte imbalances. The increased level of Na+ (155.0 mEq/L) indicates Hypernatremia that is the result of the hyperventilation and the water loss in Mr. Davis. The signs of this imbalance are sweating and changes in breathing (McCance & Huether, 2014). Observed Hyperkalemia (6.2 mEq/L) and Hyperchloremia (120.0 mEq/L) that are determined with the help of the laboratory analysis are typical for the metabolic acidosis.

## The Anion Gap

When the metabolic acidosis is observed, it is significant to calculate the anion gap because different levels are characteristic for various types of the metabolic acidosis. The used formula is the following one:

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Anion gap = (Na + [K+]]) – ([Cl-] + [HCO3-]) = 10-12 mEq/L

(Na + [K+]]) – ([Cl-] + [HCO3-]) = 161.2 – 136 = 25.2 mEq/L

Calculations demonstrate that, in case of Mr. Davis, the anion gap is significantly higher than the normal level. The primary cause of increasing the anion gap significantly is the alcohol consumption (Habermann & Ghosh, 2007, p. 112). This cause is also relevant for the case of Mr. Davis. The calculation of the anion gap is important in this situation because it is necessary to determine the type of the metabolic acidosis with its dependence on the accumulation of chloride. It is significant to calculate the anion gap in case of Mr. Davis in order to state whether the imbalance is caused by the kidney diseases or by other problems like Ketoacidosis, Uremia, and the ingestion of toxins. For Mr. Davis, the extremely high anion gap demonstrates the alcohol consumption as the cause of intoxication leading to the metabolic acidosis.

## Respiratory and Renal Systems Responses

Having analyzed the case, it is possible to state that Mr. Davis’s respiratory and renal systems worked to compensate the metabolic acidosis. First, the respiratory system responded with the reduction in pCO2. As a result, the alveolar ventilation increased (Habermann & Ghosh, 2007). The breathing of Mr. Davis became rather deep and rapid. In addition, the compensatory response was typical for the renal system because it is stated that Mr. Davis visited the restroom several times during one hour. The kidneys attempted to compensate the problem with the decreasing the H+ ions in the urine.

## Glucose Level and Urine Ketones

The low glucose level is usually typical for the metabolic acidosis caused by the alcohol consumption. The high level of urine ketones is also typical for the case because ketones are products of metabolism, and their presence indicates the dehydration associated with the intoxication of the organism and the renal system compensatory responses (McCance & Huether, 2014). In these cases, the level of glucose is not increased, and the low values for glucose are often observed along with the presence of ketones.

## The Protein Level

The presence of the protein in the urine analysis is abnormal, but such results are possible in case of the metabolic acidosis and excessive alcohol consumption. It is not normal for a person with the history of hypertension to have the protein in the urine. However, proteinuria can also be a result of intoxication. If a person, like Mr. Davis, demonstrates the presence of all such signs as the presence of ketones, the presence of protein, and the low level of glucose, it is important to examine the case in detail in order to avoid cases of diabetes and kidney diseases (Rosdahl & Kowalski, 2008, p. 118). The examination of the case of Mr. Davis allows excluding such diseases as diabetes and kidney diseases from the discussion of the metabolic acidosis causes.

## Conclusion

The analysis of the case shows that the primary cause of the observed conditions in Mr. Davis is the metabolic acidosis. The possible cause of the acid-base imbalance is determined with references to the analysis of the laboratory results. The observed changes in the acid balance can be discussed as caused by the alcohol consumption.

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## References

Habermann, T. M., & Ghosh, A. K. (2007). Mayo Clinic internal medicine concise textbook. New York, NY: CRC Press.

McCance, K., & Huether, S. (2014). Pathophysiology: The biological basis for disease in adults and children (7th ed.). St. Louis, MO: Mosby.

Rosdahl, C. B., & Kowalski, M. T. (2008). Textbook of basic nursing. New York, NY: Lippincott Williams & Wilkins.

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