ABG 1

A 50 year old male with chronic obstructive pulmonary disease is admitted

for follow-up. His respiratory rate is 25 per minute. An arterial blood gas study
revealed the following:

 pH = 7.47

 PaCO2 = 28 mm Hg

 HCO3- = 30 mEq/L

1. What is the acid-base disturbance revealed by the ABG report? (1)

Respiratory alkalosis

2. What is the reason for the altered serum bicarbonate value? (1)

Renal compensation for the alkalosis by conservation of bicarbonate ions

3. What is the reason for the altered PaCO 2 value? (1)

Hyperventilation

4. Name 2 other respiratory conditions that can cause this disturbance. (2)

Pulmonary oedema

Pulmonary embolism

ABG 2

A 5 year old girl with a history of bronchial asthma reported to the

casualty in a lethargic state. After initial measures to improve ventilation failed,
she is admitted to the ICU for further management. Her ABG values are as
follows:

pH = 7.32

PaCO2 = 55 mm Hg

HCO3- = 17 mEq/L
PaO2 = 85 mm Hg

1. What is your comment on the acid-base status of the patient? (1)

There is respiratory acidosis.

2. What is the cause? (1)

Impaired alveolar ventilation due to airway obstruction

3. List 2 measures taken to improve the ventilation in a patient presenting with an acute
episode of bronchial asthma? (2)

Administration of β2-adrenergic agonists

Administration of inhaled or systemic steroids

4. What are the normal values of PaO2 and PaCO2? (2)

PaO2 = 95 mm Hg

PaCO2 = 40 mm Hg

ABG 3

A 62-year-old man with a history of diabetes mellitus for over 10 years is

admitted with complaints of dyspnoea, nausea and vomiting. His ABG analysis
shows the following:

pH = 7.32

PaCO2 = 36 mm Hg

HCO3- = 14 mEq/L.

1. What is the acid-base disturbance noted from the ABG analysis? (1)
Metabolic acidosis

2. What is the cause of the disturbance in this case? (1)

Overproduction of keto acids

3. Give two other conditions that can cause this acid-base disorder. (2)
 Renal failure
Diarrhoea

4. What is the reason for dyspnoea in this patient? (1)

Respiratory compensation by hyperventilation to reduce the CO 2 level

SE1

A 62-year-old man is admitted to the hospital in a semiconscious state with

history of diarrhea and vomiting for 2 days. On examination, the skin turgor was
reduced. Tachycardia and hypotension was present.

A serum electrolytes test showed the following:

Na+ = 165 mEq/L

K+ = 4.0 mEq/L

HCO3- = 22 mEq/L

Cl- = 112 mEq/L.

1. What is your comment on the serum sodium value? (1)

There is hypernatremia.

2. List 2 other conditions that can produce this electrolyte imbalance. (2)
Diabetes insipidus
Hyperaldosteronism

3. How is this electrolyte imbalance classified? (1)

Hypovolemic hypernatremia and hypervolemic hypernatremia

4. What is the mechanism that would attempt to correct this fluid-electrolyte

imbalance in a conscious patient? (1)
Thirst

SE2
 A 55-year-old woman with a history of hypertension presented with
complaints of sudden onset of muscle weakness, cramps and palpitations.
She had been on antihypertensive therapy for the past two years and her
physician had recently added a diuretic to her list of medications. On
examination, tachycardia and hypotension was noted. Muscle power was
3/5 and tendon reflexes were decreased.
Laboratory tests showed the following:
Na+ : 137 mmol /L
K+ : 2.1 mmol /L
Cl- : 108 mmol /L
HCO3-: 16 mmol /L
Electrocardiography revealed a prolonged PR interval and prominent U
waves.

1. What is the electrolyte disorder responsible for this condition? (1)

Hypokalemia

2. What is the normal range for this serum electrolyte? (1)

The normal serum potassium level is 3.5-5.0 mEq/L.

3. What is the cause of this disorder? (1)

Diuresis

4. Give 2 other conditions that can present with this disorder. (2)
Protracted diarrhea
Hyperaldosteronism

SE3

A 64 year old male with diabetes and chronic renal failure presented with
muscle weakness. A preliminary serum electrolytes test showed the following:

Na+ : 130 mmol /L

+
K : 7 mmol /L
-
Cl : 108 mmol /L
-
HCO3 : 16 mmol /L

1. What is the electrolyte imbalance in this patient? (1)

Hyperkalemia
2. Give 2 other conditions that can cause this imbalance. (2)

Diabetic ketoacidosis

Severe burns

3. What will be the typical ECG findings in this patient? (2)

Tall T waves

Prolonged QRS complexes