1.. After a prolonged period of vomiting, metabolic acidosis develops. This change results from a number of factors:
• Loss of bicarbonate ions in duodenal secretions
• Lack of nutrients leading to catabolism of stored fats and protein with production of excessive amounts of ketoacids
• Dehydration and decreased blood volume leading to decreased excretion of acids by the kidney
• Decreased blood volume leading to decreased tissue perfusion, less oxygen to cells, and increased anaerobic metabolism with increased lactic acid
• Increased muscle activity and stress leading to increased metabolic acid production
These factors lead to an increased amount of acids in the blood, which bind with bicarbonate buffer and result in decreased serum bicarbonate and decreased serum pH or metabolic acidosis.
(1) List several reasons why Mr. K.B. is lethargic and weak.
(2) Predict the serum level of carbon dioxide or carbonic acid in this case.
(3) If Mr. K.B. continues to lose body fluid, why might serum pH decrease below 7.35?
(4) If serum pH drops below 7.35, what signs would be observed in Mr. K.B.?
(5) Describe the effect of acidosis on serum potassium levels.
(6)Mr. K.B. will be given replacement fluid therapy. Why is it important that sodium and potassium be given as well as water?