Activity 1.2 Discussion Forum ( Fever )

With the early vomiting, we could expect Mr. K. B’s serum pH to be between 7.4 and 7.45. (VanMeter, Hubert p 32)

How would you have expected Cari’s decreased Pco2 and alkaline blood pH to have affected her

4. Why does potassium concentration rise in patients with acidosis? What is this called? What effects does it have?

A diagnosis of sepsis includes a suspected or confirmed infection that is usually accompanied by a body temperature above 101 F (38.3 C) or below 96.8 F (36 C), a heart rate higher than 90 beats a minute and/or a respiratory rate above 20 breaths per minute.

Per PA Wu, your labs were normal except your blood sugars. Your A1c level is 0.1 higher than the last time you had it drawn and it consider to be in the pre- diabetic range. Please eat a low carb diet and include exercise in your daily regimen.

Assessment – If as a paramedic you suspect sepsis then you should question the patient if they have been recently been hospitalized or have had medical procedures that may be invasive performed on them or treatments or medications that may have weakened their immune system. Look for the prehospital criteria that point you in the direction of sepsis, so temperature above 38oC or below 36oC, respiratory rate of 20 or more, and heart rate above 90 beats per minute. Ask the patient if they have been recently diagnosed with an infection or illness. There are some different diagnoses that may have some similar signs and symptoms as sepsis; these include other infections, diabetic ketoacidosis, a myocardial infarction, and a pulmonary embolism. To rule some of these out you can perform some simple tests like listening to lung sounds, 12 lead if they have chest pain, and smell or breath (ketoacidosis would be fruity). Ultimately however the only way to get the diagnosis is through blood tests and scans. For this patient you should do the regular assessment you do for every patient as well, so take vitals, get their information (ex: SAMPLE and OPQRST), SpO2, and 4

His abnormal results were: urine protein presence, blood urea nitrogen 37 mg/dL (high), creatinine 1.9 mg/dL (high), chloride level 110 mmol/L (high), calcium level 8.3 mg/dL (low), total protein 5.6 g/dL (low), and albumin 2.7 g/dL (low). Normal levels of these results are: absence of protein in urine, blood urea nitrogen 8-21 mg/dL, creatinine 0.61-1.21 mg/dL, chloride level 97-107 mmol/L, calcium level 8.2-10.2 mg/dL, total protein 6-8 g/dL, and albumin 3.4-4.8 g/dL (Bladh et al., 2013). These abnormal lab results can be caused by and related to many

Of great concern with HHS is a higher mortality rate. HHS occurs when high glucose levels and dehydration slowly increase each other until both are extreme. Another differing key feature of HHS is the presence of neurological changes and absence of ketones. In contrast HHS occurs more often in older adults, but can occur in children with type one and type two diabetes during periods of illness. Moreover, HHS is often the presenting event that leads to diagnosis of type two diabetes (Diabetes Info, 2016). Precipitating events for HHS include illness such as diarrhea, pneumonia, sepsis, a cardiac event and/or decreased fluid intake leading to extreme hyperglycemia. Glucose levels in HHS are in excess of 180 mg/dl often rising to over 600mg/dl, resulting in the kidneys inability to reabsorb the glucose. Of consequence, the profound dehydration and hyperosmolality greater than 350 mOsm/kg, simply cannot be corrected from drinking fluids and requires IV therapy, potential electrolyte replacement and hospitalization (Mensing, McLaughlin, & Halstenson, 2011) (Childs, Cypress, & Spollett,

The possible causes of this acid base imbalance are the vomiting and the overuse of antacids. As the name implies it is bicarbonate which has been added to the body. The vomiting reduces the extracellular fluid and this in turn leads to a release of angiotensin and aldersterone. This release then increases the bicarbonate absorption and increased hydrogen ion and potassium excreted. This patient may also have hypokalemia which is very common in metabolic alkalosis and would need to be replaced if it occurred ( Thomas, 2015). The respiratory rate would also slow to try and compensate for the alkalosis.

The contribution of lactate overproduction to the development of metabolic acidosis seems clear in certain disorders. As an example, plasma lactate levels may transiently increase to 15 to 25 meq/L after a grand mal seizure or with maximal exercise [6], and the blood pH can fall as low as 6.8 [7,8]. However, the rate of lactate utilization in such patients can also increase rapidly, reaching rates as high as 320 meq/hour [2]. As a result, blood pH and plasma bicarbonate levels rapidly return to normal after the seizure or exercise has ceased.

After examining the acid-base gas levels, the patient is diagnosed with metabolic alkalosis with partial compensation because of the increase of base components due to baking soda consumption and the decrease of acid components by excessive vomiting. The patient’s pH level is 7.48, which is above the normal range of 7.35-7.45 labeling it a base. A base lowers the amount of free hydrogen ions in solution and although a weak base, it can prevent major changes in the body fluid pH. An example of a weak base is bicarbonate or HCO3 which levels are high as well at 34mEq/L. The normal range for HCO3 is 22-24. The PaCO2 level of 55mmHg is labeled an acid due to its high level. The normal range is 35-45 with less than 35 resulting in alkalosis and greater than 45 as acidosis. The acid-base balance of the blood has an excess of base resulting in alkalosis. Alkalosis is a decrease in the free hydrogen ion

Ms. Blake ABG means she has an uncompensated metabolic acidosis with a positive anion. This means she has an acidosis associated with an anion other than chloride. The anion gap measures the difference between an anions and a non-anion in serum (Kraut & Nagami. 2013). The test is routinely performed in patients with known acidosis, altered mental status, unknown exposures, acute renal failure, and acute illnesses. In Ms. Blake’s situation, her pH is less than 7.30, and her HCO3- is less than 24mEq/L. She has an acidosis that is caused by starvation and/or diabetes related illness. Usually, when an individual is in the metabolic acidosis state, he or she may encounter hypoxia. In this case, Ms. Blake PO2 is less than 80; so therefore, supplemental

The tests came back and nothing seemed to stick out. Her glucose level was slightly elevated but not enough to cause the lethargia and inappetence she was exhibiting. Dr. Brian Stockinger told the keepers to keep an eye on her and watch for developing signs or signs of improvement. A few days later, the keepers had noted in the reports that she has

The fever could be the result of infection caused by kidney stones. Sometimes patients don't have a fever but they feel groggy.

Our first thought of fever is the association with a common cold, but in some cases fever can be symptoms of other types of infections. The human body is a complex and sophisticated machine, in which all of the components must maintain a complex balance in order to ensure optimal function. This is known as homeostasis and there are various homeostatic variables in which temperature is one of them. Homeostasis ensures that the body’s internal environment is kept at fairly constant/stable core properties. A fever is usually triggered by an infection and is a natural inflammatory response. Fever is an elevation in the body temperature that is caused by cytokine-induced upward displacement of the hypothalamic thermoregulatory center (Mattson-Potth,2014). A fever is caused by numerous types of microorganisms and substances called pyrogen. When these pyrogens release chemicals into the bloodstream, the human resets the hemostat to a higher temperature. The following paper will explain how fever is often related to a bacterial infection, clinical manifestations of localized inflammation, blood work order when there is a suspected bacterial infection and manifestation of a systematic response to an infection.