AHP217 Case Histories Acid-Base Imbalances (1)

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Case History 14: Acid-Base Physiology Normal Levels of Substances in the Arterial Blood: pH 7.40 + 0.05 pCO 2 (partial pressure of carbon dioxide) 40 mm Hg pO 2 (partial pressure of oxygen) 90 - 100 mm Hg Hemoglobin - O 2 saturation 94 - 100 % [HCO 3- ] 24 meq / liter Vignette #1: A 14-year-old girl with cystic fibrosis has complained of an increased cough productive of green sputum over the last week. She also complained of being increasingly short of breath, and she is noticeably wheezing on physical examination. Arterial blood was drawn and sampled, revealing the following values: pH 7.30 pCO 2 50 mm Hg pO 2 55 mm Hg Hemoglobin - O 2 saturation 45 % [HCO 3- ] 24 meq / liter Questions : 1. How would you classify this girl's acid-base status? 2. How does cystic fibrosis cause this acid-base imbalance? 3. How would the kidneys try to compensate for the girl's acid-base imbalance?

4. This girl has also had a long history of diarrhea and poor weight gain. Explain why. 5. List some other causes of this type of acid-base disturbance. Vignette #2: A 76-year-old man complained to his wife of severe sub-sternal chest pains that radiated down the inside of his left arm. Shortly afterward, he collapsed on the living room floor. Paramedics arriving at his house just minutes later found him unresponsive, not breathing, and without a pulse. CPR and electroconvulsive shock were required to start his heart beating again. Upon arrival at the Emergency Room, the man started to regain consciousness, complaining of severe shortness of breath (dyspnea) and continued chest pain. On physical examination, his vital signs were as follows: Systemic blood pressure 85 mm Hg / 50 mm Hg Heart rate 175 beats / minute Respiratory rate 32 breaths / minute Temperature 99.2 o F His breathing was labored, his pulses were rapid and weak everywhere, and his skin was cold and clammy. An ECG was done, revealing significant "Q" waves in most of the leads. Blood testing revealed markedly elevated creatine phosphokinase (CPK) levels of cardiac muscle origin. Arterial blood was sampled and revealed the following: pH 7.22 pCO 2 30 mm Hg normal 35-45 pO 2 70 mm Hg normal-75-100 Hemoglobin - O 2 saturation 88 % normal 94-100% [HCO 3- ] 2 meq / liter normal 24 meg/liter Questions : 1. What is the diagnosis? What evidence supports your diagnosis? Metabolic Acidosis( Metabolic acidosis is characterized by an increase in the hydrogen ion concentration)

2. How would you classify his acid-base status? What specifically caused this acid-base disturbance? The carbon dioxide in the blood would cause the blood to be too acidic 3. How has his body started to compensate for this acid-base disturbance? The body has started breathing harder to try release some of the carbon dioxide that has built up. 4. What would his blood pH be if his body had not started compensating for the acid-base disturbance? Show your work. If his body doe not start 5. List some other causes of this type of acid-base disturbance. Vignette #3: A 28-year-old woman has been sick with the flu for the past week, vomiting several times every day. She is having a difficult time keeping solids and liquids down, and has become severely dehydrated. After fainting at work, she was taken to a walk-in clinic, where an IV was placed to help rehydrate her. Arterial blood was drawn first, revealing the following: pH 7.50 pCO2 40 mm Hg pO2 95 mm Hg Hemoglobin - O2 saturation 97%

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[HCO3-] 32 meq / liter Questions : 1. How would you classify her acid-base disturbance? Acidosis 2. Why might excessive vomiting cause her particular acid-base disturbance? 3. How would the kidneys compensate for this acid-base disturbance? 4. List some other causes of this type of acid-base disturbance.

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