Question

During transport to the hospital, vital signs were reassessed: HR 138, BP 75/50, RR 38 with confusion. She was diagnosed with hypovolemic shock and IV fluids were doubled. Blood samples were sent for typing and cross-matching and for both chemical and hematologic analysis. Labs Chemistry (Electrolytes) Levels 136 meq/L 3.5 meq/L 109 meq/L 37 mg/dL 1.9 mg/dL Glucose 157 mg/dL 9.0 mg/dL Hematologic (blood) Levels Hemoglobin (Hb) 8 g/dL Hematocrit (HCT) 25 % 178,000/mm3 6,3000/mm3 ABGS Pa02 53 mm Hg Na+ paCO2 52 mm Hg pH K+ Plt 7.31 Cl- WBC Sa02 84% BUN 25 mg/dL HCO3 Cr PT 12.1 sec PTT 33 sec Ca+ Patient Case Question 3. Is it necessary that sodium bicarbonate (HCO3) be administered to the patient at this time? Oxygen was started at 3L/min by nasal cannula. Repeat arterial blood gases were: paO2 82 mm Hg, paCO2 38 mm Hg, pH 7.36, and SaO2 95 % Patient Case Question 4. Are arterial blood gases results improving or deteriorating? ER doctor chose not to start a central venous line. An indwelling Foley catheter was inserted with return of 180 mL of amber-colored urine. Urine output measured over the next hour was 14 mL. K.W. condition improved after being given 1 liter of Lactated Ringer's solution and two units packed red blood cells (PRBCS) over the next hour.

Answer 1

Q. No. 3. Answer :

Yes, necessary to administer sodium bicarbonate for these patient. Because patient is in metabolic acidosis.

* to compensate that we need to administer sodium bicarbonate.

* here the patient is having ph is low that is 7.31that indicates acidosis.

*the normal Pao2 levels in ABG 75 to 100 mm of hg.

* PaCo2 levels in ABG 38 to 42 mm of hg.

* but here Pao2 is 53 mmof hg and PaCo2 is 52 mm of hg. And ph also low, it indicates metabolic acidosis.

* in these inability to form the HCO3 ^- ions leads to death.

* so bicarbonate injection is necessary to reduce metabolic acidosis.

Q. No. 4. Answer :

Yes, ABG levels improved because as said above the normal values like Pao2 improved from 53 mm of hg to 93 mm of hg.

Pco2 decreased from 52 mm of hg to 38 mm of hg.

Ph also improved from 7.31 to 7.38.

And Sao2 also came for normal value that is to 95 %.