| Course | PA 524 Comprehensive Clinical Module Nephrology & Genitourinary |
|---|---|
| Week | 6 |
| Paper type | Acid-base disorder set |
| Length | About 720 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 524 Week 6
Acid-Base Disorder Set: Four Items From G.H.'s Admission and the Problem Set, Each With Its Primary Disorder, Expected Compensation as a Number, the Size of the Miss and a Delta Comparison Where the Gap Is Raised
Student Name
Chamberlain University
PA 524: Comprehensive Clinical Module Nephrology & Genitourinary
Instructor Name
Month Day, Year
Acid-Base Disorder Set: Four Items From G.H.'s Admission and the Problem Set, Each With Its Primary Disorder, Expected Compensation as a Number, the Size of the Miss and a Delta Comparison Where the Gap Is Raised
Item 1: G.H., Admission Day, After Diarrhea
Values: pH 7.31; PaCO2 31 mm Hg; HCO3 15 mEq/L; sodium 126; chloride 103; albumin 3.2 g/dL.
Primary: metabolic acidosis, since pH is low and bicarbonate is low.
Expected PaCO2 by Winter's formula: 1.5 multiplied by 15, plus 8, equals 30.5, plus or minus 2, so 28.5 to 32.5.
Reported: 31. Verdict: compensation appropriate; no second respiratory disorder.
Anion gap: 126 minus the sum of 103 and 15 equals 8. Corrected for albumin, adding 2.5 for each 1 g/dL below 4.0: 8 plus 2, about 10. Normal gap.
Classification: normal anion gap (hyperchloremic) metabolic acidosis, consistent with bicarbonate lost in diarrhea (Kraut & Madias, 2007).
Item 2: G.H., Day 3, After Isotonic Saline
Values: pH 7.35; PaCO2 35; HCO3 19; sodium 135; chloride 108; albumin 3.0.
Primary: mild metabolic acidosis.
Expected PaCO2: 1.5 multiplied by 19, plus 8, equals 36.5, range 34.5 to 38.5.
Reported: 35. Verdict: appropriate.
Anion gap: 135 minus 127 equals 8; corrected for albumin, about 10.5. Normal gap.
Classification: persisting normal gap acidosis, now partly from the large volume of chloride-rich saline as well as ongoing stool losses.
Item 3: Problem Set, Vomiting
Values: pH 7.50; PaCO2 48; HCO3 36; sodium 138; chloride 88.
Primary: metabolic alkalosis.
Expected PaCO2: 0.7 multiplied by the rise in bicarbonate (36 minus 24, so 12), which is 8.4, added to 40, equals 48.4, plus or minus 2.
Reported: 48. Verdict: appropriate.
Anion gap: 138 minus 124 equals 14, at the upper edge of normal, which is common in alkalosis because albumin carries more negative charge at a higher pH.
Classification: metabolic alkalosis with appropriate compensation, consistent with loss of stomach acid.
Item 4: Problem Set, Diabetic Patient Found Confused
Values: pH 7.18; PaCO2 38; HCO3 14; sodium 140; chloride 101; albumin 4.0.
Primary: metabolic acidosis.
Expected PaCO2: 1.5 multiplied by 14, plus 8, equals 29, range 27 to 31.
Reported: 38. The size of the miss: 7 above the upper limit. Verdict: a second disorder, respiratory acidosis, is present; the lungs are not compensating.
Anion gap: 140 minus 115 equals 25. Raised.
Delta comparison: the gap rose by 25 minus 12, which is 13; bicarbonate fell by 24 minus 14, which is 10. The ratio is 1.3, within the range of 1 to 2 expected for a pure high-gap acidosis, so no third, normal-gap disorder is suggested (Berend et al., 2014).
Classification: high anion gap metabolic acidosis with a concurrent respiratory acidosis.
Item 5: Problem Set, Two Metabolic Processes at Once
Values: pH 7.20; PaCO2 25; HCO3 10; sodium 138; chloride 108; albumin 4.0.
Primary: metabolic acidosis.
Expected PaCO2: 1.5 multiplied by 10, plus 8, equals 23, range 21 to 25. Reported: 25. Verdict: appropriate.
Anion gap: 138 minus 118 equals 20. Raised.
Delta comparison: the gap rose by 8; bicarbonate fell by 14. The ratio is about 0.6, below 1, so bicarbonate has fallen more than the gap explains, which suggests a normal-gap acidosis alongside the high-gap one.
Classification: combined high-gap and normal-gap metabolic acidosis, as seen when a patient with ketoacidosis also has diarrhea or has received large volumes of saline.
The Note at the End
Two cautions apply to the whole set. First, the albumin correction matters: in Items 1 and 2, an uncorrected gap of 8 would look normal either way, but in a patient with very low albumin an uncorrected gap can hide a high-gap acidosis. Second, the delta comparison is a rough tool, and its cut points vary between sources; it suggests rather than proves a mixed disorder. For G.H., the set shows a normal-gap acidosis from diarrhea, worsened by saline, that is expected to resolve as the stools settle and fluids change from saline to a balanced solution.
References
Berend, K., de Vries, A. P. J., & Gans, R. O. B. (2014). Physiological approach to assessment of acid-base disturbances. New England Journal of Medicine, 371(15), 1434-1445. https://doi.org/10.1056/NEJMra1003327
Kraut, J. A., & Madias, N. E. (2007). Serum anion gap: Its uses and limitations in clinical medicine. Clinical Journal of the American Society of Nephrology, 2(1), 162-174. https://doi.org/10.2215/CJN.03020906
Reading the PA 524 Week 6 instructions
Week six asks for a set of acid-base problems solved in a consistent format. Work the items in the order printed. For each, write a one-line classification of the primary disorder, then calculate the compensation that disorder should produce, as a number with its range. Compare it with the reported value and give a verdict; where they do not match, name the second disorder and the size of the miss. For any metabolic acidosis, calculate the anion gap, correct it for albumin where albumin is given, and, if the gap is raised, compare the rise in the gap with the fall in bicarbonate to look for a third process. Keep each item as a short block rather than prose. Close with a brief note on cautions that apply to the whole set. Cite the formulas you use.
Inside the PA 524 Week 6 example
Item 1, G.H. on admission, is a metabolic acidosis with a Winter's range of 28.5 to 32.5 matched by a PaCO2 of 31 and a gap of 8 corrected to about 10, read as bicarbonate lost in diarrhea. Item 2, after saline, shows a persisting normal-gap acidosis partly from chloride. Item 3 is a vomiting alkalosis with an expected PaCO2 of 48.4 matched by 48. Item 4, a confused diabetic patient, misses Winter's range by 7, revealing a respiratory acidosis, with a gap of 25 and a delta ratio of 1.3 citing Berend. Item 5 has a gap of 20 and a ratio near 0.6, revealing a coexisting normal-gap acidosis. The closing note explains the albumin correction and treats the delta ratio as a suggestion rather than proof, citing Kraut and Madias.
Reading the PA 524 Week 6 grading rubric
Points in this set follow method. Items answered with a label but no expected compensation, or with compensation described as appropriate without a number, lose the most. Faculty check each calculation; an arithmetic slip that changes the verdict costs more than one that does not. Credit goes to naming a second disorder whenever the reported value falls outside the expected range, and to stating the size of the miss. The anion gap must be calculated and, where albumin is given, corrected; skipping the correction is a common deduction. Delta comparisons earn marks when performed only for raised gaps and interpreted cautiously. Consistent block format across items matters for readability. Formulas should be cited, and the closing note is marked for relevant cautions.
Common PA 524 Week 6 mistakes, and how to avoid them
Acid-base sets usually go wrong when students jump from the pH to a diagnosis and skip the compensation arithmetic. Share the items from your problem set, and the worked set prepared for you would solve each in the same block: primary disorder, expected compensation with its range, the reported value and a verdict. Anion gaps are calculated and corrected for albumin when it is given, and delta comparisons are added where the gap is raised. Second and third disorders are named with the size of the miss. If your course uses different compensation rules, the set applies them. A closing note lists cautions relevant to your items. Rework every calculation yourself from your own values before submitting.
Get a PA-524 Week 6 example written to your instructions
Send the problem set itself, or a sample item if the full sheet has not been posted yet, and a worked example matching its format comes back inside 24 to 48 hours, the first one free. If your section teaches a particular compensation rule, name it and the arithmetic follows that one.
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PA 524 Week 6 questions, answered
Which compensation rule should the example use?
Whichever one your section teaches, because they differ slightly and a marker redoing the item works from the version taught in class. Name it when you send the set and the arithmetic is built on it throughout. Where nothing has been specified, the example states the rule it used at the top so every item below can be checked against the same standard.
Do the items need a clinical scenario attached?
Some sets give values alone and some wrap each item in two lines of history. The example matches yours. Where a scenario is supplied, it is used to choose between the processes the arithmetic has already allowed, never to reach a conclusion the numbers do not carry. That ordering is itself marked in several sections and is easy to invert without noticing.
How many items does a finished set usually have?
Counts differ between sections, so the example is built to whatever number yours publishes rather than to a standard one. What matters more is that the items are not all the same kind: a set worth its marks contains at least one simple disorder, one compensated, and one carrying two processes, and the finished example keeps that spread when it has to invent items.
Where can I find a free PA 524 Week 6 sample paper?
The full PA 524 Week 6 acid-base set is on this page, five items each solved with expected compensation, the anion gap and a delta comparison where needed.
How does the PA 524 Week 6 sample find a hidden respiratory acidosis?
In Item 4 the expected PaCO2 from Winter's formula is 27 to 31, but the reported value is 38, so the lungs are not compensating and a second disorder is present.