A medical team is reviewing arterial blood gas and basic metabolic panel results for several patients in the intensive care and step-down units. Match each patient's clinical presentation with their most likely primary acid-base disturbance.
- A 22-year-old with recurrent vomiting due to severe gastroparesis, presenting with dehydration and muscle crampsMetabolic alkalosis with hypochloremia and hypokalemia
- A 28-year-old presenting with perioral numbness and carpopedal spasm during a severe panic attackAcute respiratory alkalosis with decreased PaCO2 and normal serum bicarbonate
- A 45-year-old with a high-output ileostomy presenting with lethargy and profound weaknessNormal anion gap metabolic acidosis with hyperchloremia
- A 55-year-old with acute mesenteric ischemia presenting with an acute abdomen and hypotensionHigh anion gap metabolic acidosis secondary to lactic acid accumulation
- A 65-year-old with a severe exacerbation of chronic bronchitis presenting with somnolence and a depressed respiratory driveAcute-on-chronic respiratory acidosis with markedly elevated PaCO2
Cevap
The correct pairings match upper GI losses to metabolic alkalosis, hyperventilation to respiratory alkalosis, lower GI losses to normal anion gap acidosis, tissue ischemia to high anion gap acidosis, and hypoventilation to respiratory acidosis.
Each clinical scenario uniquely maps to a single primary acid-base disturbance: vomiting causes H+ loss (alkalosis), hyperventilation blows off CO2 (respiratory alkalosis), an ileostomy loses HCO3- (normal AG acidosis), ischemia generates lactate (high AG acidosis), and hypoventilation retains CO2 (respiratory acidosis).
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Anahtar Kavram
Different clinical scenarios produce distinct primary acid-base disturbances based on the underlying mechanism (e.g., GI loss of acid vs. base, tissue hypoxia, ventilation changes).