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

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

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

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

Answer 1

Answer1-Disorder Primary Change Compensatory Response

Metabolic acidosis ↓ [HCO32] ↓ pCO2 1.2 mm Hg for each 1 mEq/L ↓ [HCO32] OR pCO2 = last two digits of pH

Metabolic alkalosis ↑ [HCO32] ↑ pCO2 0.7 mm Hg for each 1 mEq/L ↑ [HCO32]

Respiratory acidosis ↑ pCO2

Intense

↑ [HCO32] 1.0 mEq/L for each 10 mm Hg ↑ pCO2

Perpetual

↑ [HCO32] 3.5 mEq/L for each 10 mm Hg ↑ pCO2

Respiratory alkalosis ↓ pCO2

Intense

↓ [HCO32] 2.0 mEq/L for each 10 mm Hg ↓ pCO2

Perpetual

↓ [HCO32] 5.0 mEq/L for each 10 mm Hg ↓ pCO2v

Answer 3-Acidosis- respiratory acidosis -

chest distortions or wounds

incessant lung and aviation route sicknesses

abuse of tranquilizers

heftiness

Metabolic acidosis-

drawn out exercise

absence of oxygen

certain drugs, including salicylates

low glucose, or hypoglycemia

liquor

seizures

liver disappointment

malignancy

kidney sickness

extreme drying out

Respiratory alkalosis-

absence of oxygen

high elevation

fever

lung illness

liver illness

salicylate harming