Author Question: An ICU patient in septic shock shows the following electrolyte panel results: a serum Na+ of 150 ... (Read 82 times)

pragya sharda · **on:** Jul 16, 2018

An ICU patient in septic shock shows the following electrolyte panel results: a serum Na+ of 150 mmol/L, a total CO2 of 18 mmol/L, lactate of 4 mmol/L, and a serum Cl level of 110 mmol/L.

The patient is hypotensive and the RT is unable to obtain an ABG for analysis. What conclu-sion(s) can be drawn regarding this patient's acid-base status?
1. The anion gap is decreased.
2. Metabolic acidosis is present.
3. Anion gap is increased.
4. Lactic acidosis is present.
a. 1, 2, and 4 only
b. 1 only
c. 2 and 4 only
d. 2, 3, and 4 only

Question 2

An RT receives a doctor's order to perform an ABG on a 71-year-old woman. Upon reviewing the patient's chart, the RT notices that the patient has a platelet count of 110 103 mcl. What should the RT do?

1. Perform ABG as normal.
2. Refuse to perform the ABG.
3. After ABG is performed, compress the puncture site for a longer time.
4. Recommend that an ABG should be performed on the patient only when it is absolutely nec-essary.
a. 2 and 4 only
b. 1 only
c. 3 and 4 only
d. 2 only

memslove · **Reply #1 on:** Jul 16, 2018

Answer to Question 1

ANS: D
The anion gap is calculated by subtracting the sum of CO2 and Cl from the Na+ (150 110 + 18). In this case the anion gap is elevated (22 mmol/L) and is consistent with a metabolic acido-sis. Normal anion gap is 8-14 mmol/L. The increased lactate values reveal the presence of lactic acidosis due to anaerobic metabolism as a cause of the metabolic acidosis in this patient. Normal lactate range is 0.7 to 2.1 mmol/L.

Answer to Question 2

ANS: C
In patients requiring arterial blood gas (ABG) testing, or who need nasotracheal suctioning, RTs must evaluate the clotting characteristics of the blood. For ABG testing, patients with an abnor-mally low platelet count, or an elevated PT and INR, will need to have the puncture site com-pressed for a longer time after the arterial sample is obtained to prevent bleeding and hematoma development. Patients with an extremely low platelet count should have an arterial puncture per-formed (or undergo nasotracheal suctioning) only when it is essential because of the extraordi-nary high risk of bleeding. Normal platelet count is 150 to 400 103 mcl.