July/2006

ANSWER 2 =C

 
DISCUSSION:

An evaluation of the serum electrolytes and renal functions is useful in detecting the presence of an acid-base disturbance. Most patients coming through the emergency room with a medical problems or a surgical problem associated with sepsis and/or vomiting will have a chemical profile. Look for abnormalities in these areas:

a. The level of bicarbonate.
b. The anion gap ([Na] – ([Cl] + [HCO₃]).
c.  An abnormal level of serum potassium.
d.  Abnormalities in the BUN and/or creatinine in serum, the renal functions.

This patient has an abnormally high serum [HCO3]. The differential diagnosis for the abnormality is metabolic alkalosis versus compensated respiratory acidosis. In this patient, the clinical history – vomiting, i.e. loss of H ⁺, suggest alkalosis, therefore, metabolic alkalosis is the preferred pathophysiologic process.