A 45-year-old diabetic has entered the hospital. Routine blood work shows that his blood pH is dropping and is currently at 7.3 (normal blood pH is about 7.4). Explain what could be occurring in the kidneys to cause a drop in blood pH. If the acidosis
cannot be reversed quickly, what type of immediate treatment might the patient need to restore kidney function? There are two types of this treatment. How do they differ from each other? What sorts of complications might be expected?
What will be an ideal response?
Some form of kidney or nephron damage has occurred, and renal failure is occurring. (Acute renal failure can be caused by inflammation, certain drugs or poisons; a diabetic, however, is more likely to be experiencing chronic renal failure, caused by the negative effects of high blood glucose levels on the blood vessels of the kidneys.) This patient will need dialysis if this does not reverse on its own. Hemodialysis uses a machine to filter the blood. Blood must be taken into the machine, filtered, and returned to the patient. Another option is continuous peritoneal dialysis (CAPD), in which dialysis fluid is placed in the abdomen and the peritoneum serves as the dialyzing membrane. Infection is a major concern with dialysis, particularly with CAPD.
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