Fluid and Electrolytes: Balance and Disturbances?

Conrad Jackson is a 28-year-old male who presents to the Emergency Department with severe fatigue and dehydration secondary to a four-day history of vomiting. During the interview, he describes attending a family reunion and states that perhaps he 鈥渁te something bad.鈥?Upon admission his vital signs are a temperature of 102.7, pulse of 116, respirations 18, and blood pressure of 86/54. The nurse also notes the patient has dry mucous membranes and tenting of skin. The physician orders an IV to be started with 0.45% normal saline, and orders a serum electrolytes and an arterial blood gas. The following results are returned from the laboratory:
Sodium (Na+) 150
Potassium (K+) 5.5
Chloride (Cl炉) 110
BUN 42
Creatinine 0.8
Glucose 86
pH 7.32
PaCO2 35
HCO3炉 20
PaO2 90
O2 Sat 98%
What is your interpretation of this arterial blood gas sample?Why would the patient have these arterial blood gasses after vomiting? Explain the high potassium? Why .45 NS?

high potassium and other electrolytes due to his dehydration...as evidenced by history of fluid loss due to vomiting, dry membranes, skin tenting, and if asked I bet his po intake of fluids has been low these 4 days of vomiting, and increased fluid loss due to fever...tachycardia due to temp and dehydration...low BP due to dehydration

treat with .45NS because Na is already high @150 so you wouldn't give 0.9NS...since his electrolytes are already high you would not give LR infusion...

the ABG values show partially compensated metabolic acidosis, with low pH and low bicarb....the low but normal PCO2 show the lungs are trying to compensate by blowing off CO2 to try to raise the pH