Dehydration with Emesis As you have learned in previous courses, homeostasis refers to the body’s

Dehydration with Emesis As you have learned in previous courses, homeostasis refers to the body’s tendency to maintain a stable equilibrium by affecting various processes. It is integral for the body to maintain a stable level of fluids, electrolytes, and pH. The fluids of the body can be separated into the intracellular fluids (in the cell) and the extracellular fluids (outside of the cell). Dehydration will occur when the fluid output exceeds fluid input, and intracellular fluid will leave the cell to restore the concentration of solutes on both sides of the membrane. Signs of dehydration can include a sense of thirst, dry mouth, oliguria (low urine output), enophthalmos (sunken eyes), and drowsiness. Overhydration will occur when the fluid input exceeds output, and extracellular fluid will enter the cell to restore the concentration of solutes. Signs of overhydration include nausea, malaise (discomfort), altered mental status, seizures, and coma. Alongside fluid homeostasis, the homeostasis of electrolytes is crucial as not only will they influence fluid dynamics, but they will also have many physiological functions. Electrolytes refer to the solutes within fluids that maintain an electric charge. These electrolytes include sodium, chloride, potassium, calcium, bicarbonate, and many others. Sodium is the most prevalent cation (positively charged particle) in the extracellular fluid throughout the body and acts to conduct nerve impulses, maintain fluid balance, and contraction/relaxation of muscles. Chloride is the most prevalent anion (negatively charged particle) in the extracellular fluid, mostly in the stomach to form hydrochloric acid, and acts in maintaining fluid balance, pH balance, stimulates the nervous system, and facilitates gas exchange between cells and the blood. Potassium is the most prevalent cation in the intracellular fluid and acts to maintain fluid balance, pH balance, nerve impulses, and controlling muscle activity. Calcium is typically stored in mineral form within bone tissue, but when it is found in the fluids of the body, blood clotting, regulating heart rhythms, muscle contractions, and various nerve functions. Bicarbonate can be found both intracellularly and in the blood plasma, and it acts to maintain pH balance in conjunction with chloride ions. Finally, pH homeostasis relies on each of the body’s fluids maintaining a specific pH range. For blood plasma, the pH range is 7.35 – 7.45, with it being slightly alkaline. Buffer systems such as the protein buffer system, phosphate buffer system, and carbonic acid-bicarbonate buffer system will help in restoring pH homeostasis if there is a deviation. If the pH falls below 7.35, the blood is in acidosis, whereas if the pH rises above 7.45, the blood is in alkalosis. The two primary systems that aid in regulation of the pH are the respiratory system and the metabolic system. Respiratoryacidosis occurs when an individual has hypoventilation (lower respiratory rate), causing carbon dioxide to build up in the blood plasma, leading to the formation of acid. Respiratory alkalosis occurs when an individual has hyperventilation (increased respiratory rate), causing carbon dioxide to be rapidly removed from the body, leading to the blood to become alkaline. Metabolic acidosis occurs when either a build-up of organic acids occurs in the body, or there is a sudden decrease in bicarbonate ions. Metabolic alkalosis occurs when acids are removed from the body, or bicarbonate ions build up. Compensation occurs when one of these systems attempts to counteract the effects of the other system. For example, in respiratory acidosis, the metabolic system may attempt to excrete hydrogen ions into the urine to be removed from the body, increasing the pH. Background: Dee Dawood, a 4-week-old infant, has come to the clinic after having been vomiting for the last several days, but it continues to get worse. Today, immediately after chestfeeding, her vomiting was so forceful, that it hit the walls behind the nursing parent. She appears to be ravenously hungry, drinks vigorously, but then will immediately vomit. Desired Outcomes: 1. Determine what is the cause of the rapid emesis. 2. Educate the parents on fluid, electrolyte, and pH balance. 3. Identify appropriate recommendations based on the examination and ultrasound findings. Findings: Dee shows evidence of dehydration including no tears while crying, sunken eyes, and lower urine output. On abdominal exam, a small, firm “lump” is identified, and ultrasound reveals that the pylorus is thickened (pyloric stenosis), leading to a decrease gastric capacity. Before she can go to surgery to relieve the obstruction, she will need to receive intravenous (IV) fluids to correct the dehydration and electrolyte imbalances. Questions: 1. Explain how an alteration in respiratory rate can compensate for a pH imbalance.

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