Brian, an 80-year-old man with a history of chronic obstructive pulmonary diseas

Question

Brian, an 80-year-old man with a history of chronic obstructive pulmonary disease (COPD) and respiratory infections, was admitted through the ER with a chronic cough and extreme dyspnea. He complained that he was unable to climb the stairs or anything that required any exertion (even washing his hair). He had been a heavy smoker but had been attempting to stop smoking by cutting back on the number of cigarettes per day. The nurse noted his temperature was 101.2°F.

Arterial Blood Gas Results

Test

Brian

Reference Range

pH

7.23

7.35-7.45

PCO2

75.0

35-45 mm Hg

PO2

28.2

83- 108 mm Hg

HCO3

32.7

22-28 mEq/L

SaO2

49.6

95-98%

COHb

8.6

Nonsmoker: 0.5 -1.5%

Smokers:

packs/day:4-5 %

> 2Packs/day:8-9%

1. What are the abnormal blood gas results?

2. What is Brian’s acid base status (abnormal, acidosis, or alkalosis)?

3. Is the condition that is responsible for the blood gases respiratory, metabolic/nonrespiratory, or mixed? Explain.

4. Is the condition acute or chronic? In other words, is it uncompensated, partially compensated, or fully compensated? Why?

5. What is the primary compensatory mechanism in this acid-base disturbance?

6. Would the oxyhemoglobin dissociation curve be shifted? If yes, what direction (right or left)?

7. What conditions are associated with this acid-base disorder?

8. Which condition is most likely explanation in this case?

Test

Brian

Reference Range

pH

7.23

7.35-7.45

PCO2

75.0

35-45 mm Hg

PO2

28.2

83- 108 mm Hg

HCO3

32.7

22-28 mEq/L

SaO2

49.6

95-98%

COHb

8.6

Nonsmoker: 0.5 -1.5%

Smokers:

packs/day:4-5 %

> 2Packs/day:8-9%

Explanation / Answer

1). Arterial blood gases (ABG) test is used to measure the partial pressures of oxygen and carbon dioxide in a sample of arterial blood. Deviation from the normal blood gas values is referred to as "abnormal arterial blood gas"

Blood pH is maintained in between 7.35 to 7.45. Any deviation in its pH value results in failure to carry oxygen. If the blood pH is reduced below 7.35, it is known as “systemic acidosis,” if pH is increased, it is known as “systemic alkalosis.”

2). It is given that the blood pH of Brian is, "7.23," means acidosis.

3). The PCO2 value is abnormally high (the person may not be able to remove the carbon dioxide effectively), so it is a "respiratory acidosis."

4). The respiratory acidosis is partly compensated (--> slight elevation of bicarbonate (HCO3) levels)

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