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: 1–2 packs/day:4–5 % > 2 Packs/day:8–9%

1. What are the abnormal blood gas results? (5 points)

2. What is Brian’s acid base status (abnormal, acidosis, or alkalosis)? (5 points)

3. Is the condition that is responsible for the blood gases respiratory, metabolic/nonrespiratory, or mixed? Explain. (5 points)

4. Is the condition acute or chronic? In other words, is it uncompensated, partially compensated, or fully compensated? Why? (5 points)

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

6. Would the oxyhemoglobin dissociation curve be shifted? If yes, what direction (right or left)? (5 points)
   

7. Briefly describe base excess and base deficit. (5 points)

8. What conditions are associated with this acid-base disorder? (5 points)

9. Which condition is most likely explanation in this case? (5 points)

Six hours later, the arterial blood gases

	Brian	Reference Range
pH	7.38	7.35–7.45
PCO2	60.0	35.45 mm Hg
PO2	78.2	83–108 mm Hg
HCO3	36.2	22–28 mEq/L
SaO2	90.6	95–98%
COHb	3.6	Nonsmoker: 0.5–1.5% Smokers: 1–2 packs/day:4–5 % > 2 Packs/day:8–9%

10. What is Brian’s acid base status at this point? (5 points)

Answer 1

Answer) Bryan is having acidosis, as his ph is below the reference range.

As Pco2 is increasing, it will cause a drop in the ph because co2 is a acidic gas. Retention of carbon dioxide in copd results in fall of ph.

Po2 is falling because airways are constricted in the copd. So enough oxygen is not able to reach the alveoli.

Bicarbonate ions increases in order to compensate the respiratory acidosis due to the copd. Kidney reabsorb more amount of bicarbonate ions to buffer acidic ph.

Saturation of oxygen is continuously falling down because airways are constricted already, enough oxygen is not reaching the alveoli. So in blood level of oxygen falls down.

Conclusion-Bryan is having respiratory acidosis, in which their is retention of co2 which causes acidic ph to be built. Enough oxygen is not able to reach the alveoli, so saturation is falling. In order to compensate, kidney starts to reabsorb more bicarbonate ions to buffer the acidic ions. In case of any respiratory acidosis, the compensation is always metabolic alkalosis.