Question

ABG problem.
Patient has respirations of 22 breaths/min, is in respiratory alkalosis and is hypoxic. What interventions do you use to fix this problem?

The answer is decrease tidal volume and decrease respirations.

For some reason I can't wrap my mind around this. If the patient is hypoxic why would we want to lower tidal volume? and increasing respirations helps us to blow off CO2 and gain more O2, so why would we decrease it?

this is what I know about ABG:

If CO2 is increased (such as in respiratory acidosis) we increase the tidal volume and increase the respirations to blow off CO2.

If CO2 is decreased (such as in respiratory alkalosis) we decrease the tidal volume and decrease the respirations.

so what I'm having trouble with is even though I know in resp. alkalosis we decrease those things, in my mind decreasing them is going to lower our already low oxygen and will kill the patient.

Answer 1

Hypoxia is often the triggering factor for tachypnea which leads to hyperventilation and then (like in this case) the person lands into respiratory alkalosis due to CO2 washout.

You have a valid doubt but you need to know that any electrolyte imbalance should be corrected first. On decreasing the tidal volume and respiratory rate, the PCO2 will go back to normal.

No, hypoxia will not kill the patient. However, if the patient continues to hyperventilate, he will further land I to metabolic acidosis which can be dangerous.

Always remember that any electrolyte imbalances need to corrected first. The hypoxia here is probably due to some other underlying cause which is triggering the respiratory centre.