Mrs. Kalen is a 70 year old female who has arrived into the ER due to persistent vomiting for two days now. She appears to be lethargic and weak and has myalgia. She is noted to have dry mucus membranes and her capillary refill takes >4 seconds. She is diagnosed as having gastroenteritis and dehydration. Measurement of arterial blood gas shows pH 7.5, PaO2 85 mm Hg, PaCO2 40 mm Hg, and HCO3 34 mmol/L. What would you interpret the acid-base disorder to be?

Each of your meals should contain about 10 tablespoons of food: After gastric bypass surgery, the stomach's size is reduced, and the patient's capacity to consume large quantities of food is limited. It is important to educate the patient about appropriate portion sizes to avoid overeating and potential complications.

Be certain to stay hydrated by drinking water: Hydration is crucial after gastric bypass surgery. Patients should be advised to drink enough water throughout the day to prevent dehydration and ensure proper bodily function.

Solid food can be introduced back into the diet in a week: Following gastric bypass surgery, the diet is initially limited to liquid and pureed foods. Gradually, solid foods can be reintroduced into the diet over time, typically after a week or as directed by the surgeon. This information is important for the patient to understand the progression of their diet post-surgery. You are likely to have little urine output for the first few weeks: This statement is not true and may cause unnecessary concern for the patient. Urine output should not be affected by gastric bypass surgery unless there are other complications.

Report any back, shoulder, or abdominal pain to the surgeon: While it is important to report any significant pain or discomfort to the surgeon, including back, shoulder, or abdominal pain, this is not specific to discharge teaching for gastric bypass surgery. Pain management and reporting should be covered during the post-operative care instructions, but it is not limited to discharge teaching alone.

The pH value of 7.5 indicates alkalosis, as it is above the normal range of 7.35-7.45. The elevated bicarbonate (HCO3-) level of 34 mmol/L suggests metabolic alkalosis, as it is higher than the normal range of 22-28 mmol/L. The PaCO2 level of 40 mm Hg falls within the normal range of 35-45 mm Hg.

In this case, the primary disturbance is metabolic alkalosis, which is likely caused by vomiting leading to excessive loss of gastric acid (hydrogen ions) and chloride ions from the stomach. This loss of acid and chloride results in an imbalance of electrolytes and an increase in bicarbonate levels, leading to metabolic alkalosis.

The arterial blood gas results do not indicate any compensation. Compensation occurs when the body attempts to restore the pH balance by adjusting the respiratory or metabolic systems. In this case, there is no compensation observed because the PaCO2 level is within the normal range and not significantly altered.