Medical Surgical Chloride #4

Question

A client with persistent severe diarrhea was admitted to the emergency department with reports of fatigue, muscle weakness, excessive thirst, and dry mucous membranes. Laboratory results indicate extreme dehydration, chloride level 120 mEq/L, ABGs: pH 7.31, PaO2 92 mmHg, PaCO2 45 mmHg, HCO3 20 mEq/L. Which acid-base imbalance is the client experiencing?

Answers

  1. Metabolic acidosis
    • Rationale:

      This answer is correct because hyperchloremic acidosis is a metabolic acidosis that can occur in a client who has had extreme loss of base, such as in persistent severe diarrhea. In response to this acidosis, the body retains chloride.

  2. Metabolic alkalosis
    • Rationale:

      This answer is not correct because hyperchloremia (chloride level 120 mEq/L) in this scenario is caused by metabolic acidosis (as reflected by the stated ABGs), specifically known as hyperchloremic acidosis, related to severe diarrhea. In response to this acidosis, the body retains chloride.

  3. Respiratory acidosis
    • Rationale:

      This answer is not correct because respiratory acidosis is not reflected in this scenario. The severe diarrhea history does not support this, nor do the labs or ABGs reflect this.

  4. Respiratory alkalosis
    • Rationale:

      This answer is not correct because respiratory alkalosis is not reflected in this scenario. The severe diarrhea history does not support this, nor do the labs or ABGs reflect this.

Overview

Hyperchloremic acidosis is a metabolic acidosis that can occur in a client who has had extreme loss of base, such as in persistent severe diarrhea. In response to this acidosis, the body retains chloride.

Explanation

Learning Outcomes

Hyperchloremia is an abnormally elevated chloride level (>107 mEq/dL). This is caused by conditions including extreme diarrhea, kidney disease, extreme intake of salt, metabolic acidosis, respiratory alkalosis, and bromide poisoning. Hyperchloremic acidosis is a metabolic acidosis that can occur in a client who has had extreme loss of base, such as in persistent severe diarrhea. In response to this acidosis, the body retains chloride. Symptoms include extreme thirst, hypertension, dry mucous membranes, fatigue, and weakness.

Test Taking Tip

Regardless of the other things that support metabolic acidosis, it can help if you think of diarrhea causes metabolic AS*adosis.

Video Rationale