A 22 year old diabetic arrived in the emergency room in a coma. Hils breathing w

Question

A 22 year old diabetic arrived in the emergency room in a coma. Hils breathing was deep and rapid and his skin and mucous membranes showed signs of severe dehydration. The pulse was rapid and faint and the blood pressure was low. Blood samples were taken and then intravenous fluid therapy began. The values of interest at the time of admission were: Plasm pH7.21 *Plasma pc02 27 mm?y Plasma HCO3 11.2 m/L "O2 saturation 97% 1. What is the status of this patient's acid-base balance at the time of admission? 2. Is the bicarbonate concentration of his cerebrospinal fluid (CSF) likely to be decreased, increased, or the same? 3. Does this help explain his increased rate and depth of breathing? (Yes or No) Several hours later, after infusion of, among other things, sodium bicarbonate, the hyperpnea was less but continue and the following values were obtained: Plasm pH 7.42 *Plasma pCO2 23 mmiHg "Plasma HCo, 35 mM/L "O2 saturation 97% 4. Now his pH is normal, so does his hyperpnea persist? (Yes or No) Forty-eight hours later, the hyperpnea had vanished and the following blood values were obtained Plasm pH 7.40 Plasma pco2 41 mmiHg *Plasma HCO" 24. mML 5. What change in his CSF has taken place that accounts for his normal breathing 48 hours later?

Explanation / Answer

Plasma Bicarbonate is Low (about 22-29mMol/L), pCO2 is also low (normal 40mmHg). pH is very slightly acidic (normal 7.35-7.45)

1) due to low bicarbonate levels, causing metabolic acidosis.

2) The CSF bicarbonate concentration will be the same as plasma's

3) the low pH, pCO2 levels are perceived by the central chemoreceptors which go on to regulate the rate of breathing and increase it so as to increase the blood pH

4) no pCO2 is still low

5) pCO2 levels have become normal now

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