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Diagnosis – Hypernatremia, Hyperchloremia, Hypoxemia, Metabolic acidosis or DKA, dehydration

Ms. Blake is an older adult with diabetes and has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time. On admission her laboratory values show:

Ms. Blake’s values
Sodium (Na⁺) 156 mEq/L
Potassium (K⁺) 4.0 mEq/L
Chloride (Cl⁻) 115 mEq/L
Arterial blood gases (ABGs) pH, 7.30; PCO₂, 40; PO₂, 70; HCO₃⁻ , 20

Normal values
Sodium (Na⁺) 136-146 mEq/L
Potassium (K⁺) 3.5-5.1 mEq/L
Chloride (Cl⁻) 98-106 mEq/L
Arterial blood gases (ABGs) pH 7.35-7.45
PCO₂ 35-45 mmHg
PO₂ 80-100 mmHg
HCO₃ ⁻ 22-28 mEq/L

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Diagnosis – Hypernatremia, Hyperchloremia, Hypoxemia, Metabolic acidosis or DKA, dehydration
Associated diseases; alcoholism and cirrhosis of the liver, CHF, kidney failure, Diabetes insipidus, respiratory infection

A) For Congestive Heart Failure where hypernatremia is indicated which of her labs and clinical symptoms could this account for it? And what could it not account for?
B) What symptoms would you expect to find in Ms. Blake?
What would be the treatment?
(make a final diagnosis and run with it as far as the treatment. Give the mechanism of action for at least one medication chosen.)
C) What do her ABGs mean?
Does she have a normal or an abnormal anion gap? Why?
(In addition, write down what abnormal conditions would cause a low anion hap, a high anion gap and a normal anion gap.)
Each question A, B, and C need to be answered separately each with proper APA referencing.

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