Florence

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Florence

• Florence has been ill and unable to get out of
  bed for two days. She is elderly with diabetes.
• Her symptoms are
• -fever
• -severe cough
• -unable to eat or drink in the two days

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Arterial Blood Gases (ABGs)

• ABGs measure the concentration of oxygen, carbon
  dioxide, bicarbonate, pH, and electrolytes in
  arterial blood.
• Florences ABGs were taken and can be used to
  help identify an appropriate treatment for her
  illness(es).

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(No Transcript)
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pH and HCO3-

• Lower pH means that there is more hydrogen ions
  present in the blood. The cause could be
  respiratory or metabolic (related to her
  diabetes).
• Because Florences CO2 level is normal, this pH
  shift is not the fault of the respiratory system.
• Bicarbonate (HCO3-) may act to buffer keto-acids
  in the body by attaching to hydrogen ions to
  resist the potential acidic change in pH. In
  Florences plasma, bicarbonate has become
  occupied by hydrogen ions causing HCO3- levels to
  decrease.

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pH and HCO3-
http//courses.cm.utexas.edu/emarcotte/ch339k/fall
2005/Lecture-Ch2/Slide26.JPG
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Electrolyte Imbalance

• Lack of water intake causes sodium levels to
  increase past normal levels. An elevated sodium
  level is referred to as hypernatremia
  (dehydration).
• Florences high chloride levels are caused by the
  high sodium levels and her diabetes. Higher than
  normal chlorine levels are termed hyperchloremia.

http//www.royalcanin.us/images/vetdiets/icons/can
inehepaticicon3.gif
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Partial Pressure of Oxygen

• Abnormal levels of PO2 are caused by a decrease
  in oxygen transfer over the respiratory membrane
  in the alveoli.
• Florences PO2 levels are only slightly below
  normal. This is known as hypoxia in medical terms.

http//tutor.lscf.ucsb.edu/instdev/sears/biochemis
try/images/hemoglobin-sat-button2.jpg
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Diagnosis

• Florences ABGs indicate she has metabolic
  acidosis possibly caused by diabetic
  keto-acidosis. This is due to her under-treated
  diabetes.
• Her coughing is caused by a respiratory infection.

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Treatment

• Begin by administering a water solution with 5
  dextrose intravenously until her sodium levels
  return to normal.
• Since she is diabetic, she would also need to be
  treated with insulin intravenously until her
  blood glucose levels return to normal.
• Her respiratory infection would also need to be
  treated with antibiotics.

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Analogy

• Systems of the body are in constant flux
• Water balance is maintained by the kidneys and
  hypothalamus
• pH is a balance between acidosis and alkalosis.
• pH (7.35-7.45)
• Bicarbonate is the primary blood buffer.
• H2O CO2 ? H2CO3
• H2CO3 ? H HCO3-

http//serc.carleton.edu/images/NAGTWorkshops/earl
ycareer/balance.gif
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Analogy
pH balance is a constant struggle regulated by
negative feedback. If one regulatory system
pulls harder than the others, an imbalance
occurs. The Push-Me-Pull-You is an example of
a balanced regulatory system. As long as the
homeostatic mechanisms at both ends are
functioning, the desired levels will be
maintained.

• http//www.llamas.co.nz/_borders/push_me_pull_you.
  jpg

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References

• Arterial Blood Gases. http//www.webmd.com/a-to-z-
  guides/Arterial-Blood-Gases.
• Arterial Blood Gases. http//user.gru.net/clawrenc
  e/vccl/chpt7/avbg.htm
• Janice Lapsansky
• Silverthorn, D. Human Physiology. Pearson
  Education. 2007.