What would be the cause of this blood gas?!
Question: What would be the cause of this blood gas!?
Elderly woman comes in the ER in CHF!.She is a 30 year smoker with a history of high blood pressure!.Her initial abg is ph 7!.31 co2 58 po2 68 hco3 32 on 4liters o2!.She is given nitro,lasix and neb treatments!.The next morning her blood gas is ph 7!.42 co2 65 po2 65 hco3 41 on 2 liters!.How did she over compensate!?Www@Answer-Health@Com
Answers:
This is basically an acute metabolic alkalosis superimposed on a chronic respiratory acidosis!.Did you look at the patients chloride or potassium levels!? This happens sometimes when the patient has been given loop diuretics!.There is an intracellular shift that pulls the bicarb into the blood!.Potassium-sparing diuretics and carbonic anhydrase inhibitors may be used in patients who require continued diuretic therapy!.The web page below will help explain it a little better!.
http://www!.emedicine!.com/med/TOPIC1459!.H!.!.!.
Hope this helps:)Www@Answer-Health@Com
http://www!.emedicine!.com/med/TOPIC1459!.H!.!.!.
Hope this helps:)Www@Answer-Health@Com
First off she didn't over compensate, she became fully compensated!. That's a huge difference!. To over compensate would make her alkalotic!. Full compensation means that even though her Bicarb and CO2 are out of whack her PH is in the normal range, thus they are compensated or balanced!.
To start with you didn't mention what her respiratory rate was!. At best guess she was most probably tachypnic due to the CHF fluid overload and COPD exacerbation resulting from the fluid in the lungs!. (Maybe even a bit of anxiety) Because of the rapid breathing rate she would be 'blowing off' CO2 even though was increasing via increased work of breathing!. But the Bicarb was being diluted in the blood system by the fluid overload!. Her pO2 is most probably normal for her in the low 60's given her medical history!.
Once treated the Lasix removed the excess fluid and helped to elevate the bicarb, the nebs slowed down the respiratory rate and increase the CO2, thus balance or homeostasis!.Www@Answer-Health@Com
To start with you didn't mention what her respiratory rate was!. At best guess she was most probably tachypnic due to the CHF fluid overload and COPD exacerbation resulting from the fluid in the lungs!. (Maybe even a bit of anxiety) Because of the rapid breathing rate she would be 'blowing off' CO2 even though was increasing via increased work of breathing!. But the Bicarb was being diluted in the blood system by the fluid overload!. Her pO2 is most probably normal for her in the low 60's given her medical history!.
Once treated the Lasix removed the excess fluid and helped to elevate the bicarb, the nebs slowed down the respiratory rate and increase the CO2, thus balance or homeostasis!.Www@Answer-Health@Com
Volume depletion and hypokalemia are the most common stimuli for increased HCO3 ? reabsorption, but any condition that elevates aldosterone or mineralocorticoids (which enhance Na reabsorption and K and H+ excretion) can elevate HCO3 ?!. Thus, hypokalemia is both a cause and a frequent consequence of metabolic alkalosis!.
Causes of Metabolic Alkalosis; the most common are volume depletion (particularly when involving loss of gastric acid and Cl from recurrent vomiting or nasogastric suction) and diuretic use!.
Depending on the diuretic used !.!.!. it could cause the increase in bicarbonate !.!.!.!. thats all I can think of !.!.!.!. hope this helps !.!.!.Www@Answer-Health@Com
Causes of Metabolic Alkalosis; the most common are volume depletion (particularly when involving loss of gastric acid and Cl from recurrent vomiting or nasogastric suction) and diuretic use!.
Depending on the diuretic used !.!.!. it could cause the increase in bicarbonate !.!.!.!. thats all I can think of !.!.!.!. hope this helps !.!.!.Www@Answer-Health@Com
neb as in nebulizer!? Maybe the inhalant or the albuterol was too much for her!?Www@Answer-Health@Com