The heavy metal extravaganza is in full swing on a pleasant Saturday evening in
ID: 3520392 • Letter: T
Question
The heavy metal extravaganza is in full swing on a pleasant Saturday evening in the rogue valley. Unfortunately, a semiconscious 19-year-old female has been discovered on the ground behind a tree. The para medics are called and quickly respond. Upon arrival they quickly assess the women and find she has an oxygen saturation of 88% on room air and pinpoint pupils. She is brought to the RVMC emergency department where a room air arterial blood gas is done. The results are as follows. pH 7.25 PCO2 60 mm Hg PO2 65 mm Hg HCO3- 26 mEq/L Base Excess 1 Her chemistry panel results show: Sodium 137 Chloride 100 Bicarbonate 27 a) What is the patient’s acid/base state? Explain why you think this is the case. b) What is the patient’s compensation condition? Explain your rational; to receive full credit you must support your rational using the base excess data. c) What is the patient’s anion gap? What does this tell you about her acid/base state in question 1? d) What does the alveolar-arterialoxygen differences tell us about the cause of our patient’s condition? e) Use the term below to give a complete summary of our patient’s condition. Use the information in the question to determine a probable cause. Explain how our choice would create this condition. Acute or chronic / compensated, partially compensated or uncompensated / metabolic or respiratory / alkalosis or acidosis.
Explanation / Answer
a) It is a case of respiratory acidosis.
b) oxygen saturation fell below 88% also her PO2 is 65 mmHg aldong with these,pCO2 is 60mmhg (above normal),and HCO3 is also above normal.
All these conditions gives a clue about respiratory acidosis.
c) anion gap= [Na+] - ( [Cl-] + [HCO3-]) = ( 137) - (100+27) = 10
Anion gap is 10 meq/L
d)since it lies in the normal range it gives a clue about acute acid base disturbance.
e) since the pH is less than 7.35,it is a condition showing increased acidity hence acidosis.
The patient is suffering from acute respiratory acidosis as she is under some kind of respiratory distress.
The conditions which causes acute respiratory acidosis are- acute respiratory distress syndrome,pulmonary edema etc.
It is a case of acute respiratory acidosis which is compensated.
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