Question

Clinical Case

A.A.T. 2 months, male, white. It was admitted to the emergency room of a public hospital in Paraná with incoercible vomiting, dehydration and severe metabolic disorder. Preterm Born Weight of 2,890g and 46 cm height of cesarean section arising from a car accident. There was no report of complications during pregnancy. In the fifth week of life, he began to present, regurgitations to breastfeeding and fever, was attended by the pediatric sector, after examinations and a bacterial infection was identified. During hospitalization, the baby presented constant vomiting and had, as a diagnosis, infection of the urinary tract. After 5 days from discharge, it was again hospitalized with incoercive vomiting staff, hypernatremia, leukocytosis, increased amiloid protein (PSA) and reactive protein (PCR), metabolic disorder and severe alkalosis. At physical examination, it was in poor general condition, oliguria and severe dehydration, with hypotrophic subcutaneous and muscular cellular fabric, with excavated and flabby abdomen and "cachectic appearance". Weight, in hospitalization, of 3,355g.

a) Identify the type of alkalosis involved in the clinical case presented and justify your answer.


B) Explain the compensation mechanism involved with the alkalosis identified in letter a.


C) Explain the mechanism of cellular adaptation regarding subcutaneous and muscle hypotrophy, relating to the data presented in the clinical case.

Answer 1

a) The type of alkalosis involved in the clinical case presented is likely metabolic alkalosis. This is indicated by the patient's clinical findings, such as incoercible vomiting, hypernatremia, and increased amiloid protein (PSA) and reactive protein (PCR). Metabolic alkalosis occurs when there is an excess of bicarbonate (HCO3-) in the body, which can be caused by conditions such as vomiting, where the loss of stomach acid (hydrochloric acid, HCl) leads to an increase in the relative concentration of bicarbonate.

b) The compensation mechanism involved with metabolic alkalosis is respiratory compensation. In response to metabolic alkalosis, the respiratory system attempts to correct the pH imbalance by decreasing the respiratory rate and depth. This reduction in ventilation leads to an increase in carbon dioxide (CO2) levels in the blood, which combines with water to form carbonic acid (H2CO3). Carbonic acid can then dissociate into bicarbonate (HCO3-) and hydrogen ions (H+), helping to lower the pH and partially compensate for the metabolic alkalosis.

c) In the clinical case presented, the mechanism of cellular adaptation regarding subcutaneous and muscle hypotrophy is likely related to the severe dehydration and metabolic disorder. Dehydration and metabolic disturbances can lead to reduced tissue perfusion, nutrient delivery, and overall cell function. As a result, cells, including muscle and subcutaneous adipose tissue cells, may undergo adaptive changes to conserve energy and resources. This can manifest as reduced cell size (atrophy), which can contribute to the hypotrophic appearance noted in the physical examination. Additionally, the "cachectic appearance" may be due to a combination of factors, including nutrient deficiencies and the metabolic stress the infant has experienced during the clinical course.

Step-by-step explanation: