Question

A 55 y/o F with severe PNA, develops acute chest pain, SOB, frequent arrhythmias and hypotension just before 10AM.  

10 AM ABG on 50% FiO₂: 7.37/37/72/25/93%

11 AM ABG on 50% FiO₂: 7.28/29/49/13/84%

a.     Classify both ABGs

b.      List abnormal clinical manifestations

c.      Interpret

d.     Make specific recommendations for treatment

Answer 1

A 55 y/o F with severe PNA, develops acute chest pain, SOB, frequent arrhythmias and hypotension just before 10AM.  

a.

at 10 am on 50% FiO2

pH = 7.37 (Normal value 7. 35 to 7.45)

PCo2 = 37 (Normal value35 to 45)

Po2 = 72 (Normal value > 80)

HCo3 = 25 (Normal value 22 to 28)

So2 = 93% (>90%)

at 11 am on same 50% FiO2

pH = 7.28 (Normal value 7. 35 to 7.45)

PCo2 = 29 (Normal value35 to 45)

Po2 = 49 (Normal value > 80)

HCo3 = 13 (Normal value 22 to 28)

So2 = 84% (>90%)

10 am ABG is almost normal but in 11 am ABG there is Acidosis.

b.

Causes of Acidosis in 11 am ABG is due to decreased level of HCO3(Bicarbonate). Due to acidosis PCO2(partial pressure of carbon dioxide) is compensating because its in alkaline range.

Oxygen saturation also decreases in 11 am ABG due to the decreased partial pressure of Oxygen(PO2), Decrease PO2 and Symptoms of patient suggest pulmonary edema.

c.

It is Metabolic acidosis

d.

Treat hypotension by vasopressors.

Administer Bicarbonate

Start oxygen therapy

Repeat ABG after 1 hour