Reference no: EM133482762
Sam Miller is a 26-year-old African American steel worker presenting to the emergency room after 48 hours of emesis, which he believes is from food poisoning. The patient reports multiple episodes of emesis as over the last 48 hours with increasing nausea and indigestion this morning and had taken two calcium carbonate (Tums) without relief. Sam has a past medical history of high blood pressure and takes hydrochlorothiazide, a loop diuretic, 25mg daily.
Physical Assessment
A/Ox4. Sam is slow to answer but states that he is tired. He reports muscle cramping "all over" and feeling weak. Sam experienced an involuntary contraction of his hand and wrist when his blood pressure was assessed and muscle twitching with facial nerve stimulation. He denies any thirst or hunger.
Vital Signs
Temp 100.9
HR 122
RR 14
BP 145/78
Laboratory Tests
Sodium 145mEq/L
Calcium 7.9 mg/dL
Potassium 3.3 mEq/L
pH 7.55
PaCO2 40
HCO3 31.
Questions to answer in your discussion of this patient.
1. Which acid-base imbalance is this patient experiencing?
2. What is the likely cause(s) of Sam's current acid/base imbalance?
3. What is causing Sam's abnormal neuromuscular findings?
a. How is this manifested?
4. What interventions should you anticipate to resolve Sam's issues and return to homeostasis.