Yesterday’s case

5 Mar
2008

Congrats to the readers, most of you understood the point. Here is my analysis.

ABG
pH 7.46
pCO2 66
pO2 61
calc HCO3 46

1. The patient is alkalotic, therefore the patient clearly has a metabolic alkalosis.

2. I had to look up the compensation for metabolic alkalosis (I remember the Winter’s equation but not this equation). The predicted pCO2 = 0.7*HCO3 + 20 (range of 5).

3. Therefore, we would expect a pCO2 of 52 (range 47-57). Since the pCO2 is greater than that, we also have a primary respiratory acidosis.

One commenter (one of my interns at UAB) wrote a wonderful summary of how this might occur. I quote:

He has a multiple reasons for a metabolic alkalosis:
1) renal compensation for resp. acidosis
2) hypokalemia and hypochloremia from diuresis
3) hyperaldo from CHF
4) Post-hypercapnic

I decided to give him a couple of doses of acetazolamide to ameliorate his metabolic alkalosis. We did that yesterday and again today. We did decrease his bicarbonate, but he continues to have a respiratory acidosis.

The reason that I presented this case was to make the points that my intern made above, and to remind us all that metabolic alkalosis and respiratory acidosis is a relatively common combination. Treating the metabolic alkalosis can help in treating the respiratory acidosis.

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Related posts:

  1. 17 days at the VA – day 12
  2. 15 days at the VA – day 3
  3. My answer to intubated
  4. AMS – an acid-base problem II
  5. ABG dilemma discussed

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3 Responses to Yesterday’s case

Avatar

Q

March 6th, 2008 at 5:58 am

Please include the following blogs in your medical blog list. I have included your blog on my site

Blog Name : QWERTYitis
URL : qwertyitis.blogspot.com

Blog Name : DrQwerty
URL : drQwerty.knows.it

Avatar

david

March 10th, 2008 at 3:08 pm

One thing to note here is not to treat this patient with BiPAP as he is already alkalotic with a pH of 7.46. Doing so could lead to an acute rise in the blood pH and possibly lead to a seizure. Once the metabolic alkalosis is corrected with the Diamox or KCl then BiPap could be used. As has been stated already, this man likely has a chronic respiratory alkalosis with a superimposed contraction (metabolic) alkalosis from Lasix diuresis. thanks

Avatar

david

March 11th, 2008 at 3:09 am

Intended to say “chronic respiratory acidosis” not
chronic respiratory alkalosis” in my response above.

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