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The acid-base state of Mr. B is partly offset by metabolic acidosis. Mr. B has hard breathing, referred to as Kussmaul breathing, which compensates for metabolic acidosis (Gandhi & Alkholkar,2015). In Mr. B’s case, lactic acidosis and the base deficiency caused metabolic acidosis. Weak perfusion and hypoxia induce lactic acidosis. Mr. B’s 70mm Hg pO2 and 88% sat O2 indicate mild to moderate hypoxemia.
Myocardial infarction raises cardiac pressure and lowers cardiac output. The renin-aldosterone-angiotensin system is activated, and renal perfusion is decreased. Renin in kidneys, which develops angiotensin II shift, is activated by renal vasoconstriction and poor perfusion (Dixon & Abbate, 2015). Angiotensin II and released norepinephrine increase vascular resistance in non-vital areas of the body and decrease filtration in the kidneys and potassium waste (Huether, 2017, p. 123). Aldosterone induces sodium reabsorption in response to Angiotensin II. Norepinephrine allows potassium to move intracellularly. Such processes facilitate hypokalemia (Dixon & Abbate, 2015). An electrocardiogram indicates hypokalemia.
Dixon, D.L. & Abbate, A. (2015). Potassium levels in acute myocardial infarction: Definitely worth paying attention to. European Heart Journal – Cardiovascular Pharmacotherapy 1(4), 252-253. https://doi.org/10.1093/ehjcvp/pvv029
Gandhi, A.A. & Akholkar, P.J. (2015). Metabolic acidosis in acute myocardial infarction. International Journal of Advances in Medicine 2(3), 260-263. http://dx.doi.org/10.18203/2349-3933.ijam20150556
Huether, S.E. (2017). Fluid and electrolytes, acid and base. In S.E. Huether & K.L. McCance (Eds.), Understanding Pathophysiology (114-133). Elsevier Mosby.
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