Abg interpretation alkalosis

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  • 1) This pt has moder8 type 1 respi impairment. Hyperventilation is an appropriate response to hypoxaemia and sensation of dyspnoea and has resulted in mild alkalaemia. (remember dat metabolic compensation does not occur in response to acute respiratory acid-base disturbance) 4) Indications for further ABG?  signs of exhaustion or hypercapnia. Or significant decline in SpO2.
  • 1) This pt has moder8 type 1 respi impairment. Hyperventilation is an appropriate response to hypoxaemia and sensation of dyspnoea and has resulted in mild alkalaemia. (remember dat metabolic compensation does not occur in response to acute respiratory acid-base disturbance) 4) Indications for further ABG?  signs of exhaustion or hypercapnia. Or significant decline in SpO2.
  • Abg interpretation alkalosis

    1. 1. CASE DISCUSSION: ALKALOSIS NOOR HAFIZAH BINTI HASSAN 2007287236
    2. 2. CASE 1 <ul><li>A 25 y/o man, with no known medical illness presented with 2 days history of fever, productive cough and worsening SOB. </li></ul>
    3. 3. <ul><li>On examination : </li></ul><ul><li>He is hot and flushed with a temperature of 39°C </li></ul><ul><li>Using accessory muscles of respiration </li></ul><ul><li>↓ chest expansion Lt LZ </li></ul><ul><li>Dull percussion note </li></ul><ul><li>↓ air entry with bronchial breathing and fine end- inspiratory crepitations at Lt LZ </li></ul><ul><li>Vital signs: </li></ul><ul><li>Pulse rate: 104/min </li></ul><ul><li>Respiratory rate: 28/min </li></ul><ul><li>BP: 118/70 mmHg </li></ul><ul><li>SpO2: 89 % under room air </li></ul>
    4. 4. <ul><li>ABG: </li></ul><ul><ul><li>pH 7.50 </li></ul></ul><ul><ul><li>PCO 2 3.74 kPa </li></ul></ul><ul><ul><li>PO 2 7.68 kPa </li></ul></ul><ul><ul><li>HCO 3 23.9 mmol/L </li></ul></ul><ul><ul><li>BE -0.5 mmol/L </li></ul></ul>Laboratory results: <ul><li>BUSE : </li></ul><ul><li>Urea 4.3 mmol/L </li></ul><ul><li>Na 138 mmol/L </li></ul><ul><li>K 3.7 mmol/L </li></ul><ul><li>Creatinine 78 mmol/L </li></ul>
    5. 5. <ul><li>Describe his gas exchange. </li></ul><ul><li>2) Describe his acid-base status. </li></ul><ul><li>Should he receive supplemental O 2 ? </li></ul><ul><li>Is pulse oximetry a suitable alternative to repeated ABG monitoring in this case? </li></ul>
    6. 6. <ul><li>Describe his gas exchange. </li></ul><ul><li>Type 1 respiratory failure </li></ul><ul><li>2) Describe his acid-base status. </li></ul><ul><li>Uncompensated respiratory alkalosis </li></ul><ul><li>Should he receive supplemental O 2 ? </li></ul><ul><li>Yes, to correct the hypoxaemia. </li></ul><ul><li>Is pulse oximetry a suitable alternative to repeated ABG monitoring in this case? </li></ul><ul><li>- With moderate hypoxaemia and no ventilatory impairment, monitoring by pulse oximeter is more appropriate than repeated ABG sampling. </li></ul><ul><li>- indications for further ABG? </li></ul>
    7. 8. CASE 2 <ul><li>A 35 y/o woman in a gynaecology ward develops severe vomiting 1 day after EL BTL. She continues to vomit continuously for a further 3 days. Examination of her fluid balance chart reveals that she is failing to keep up with her fluid losses but has not been prescribed intravenous fluids. </li></ul>
    8. 9. <ul><li>On examination: </li></ul><ul><li>- She appears dehydrated, with ↓ skin turgor and dry mucous membrane. Abdominal examination is normal. </li></ul><ul><li>- V ital signs: </li></ul><ul><li> PR: 100 beats/min </li></ul><ul><li> BP: 160/100 mmHg </li></ul><ul><li> RR: 10 breaths/min </li></ul><ul><li> T: 36.6 °C </li></ul>
    9. 10. <ul><li>ABG: </li></ul><ul><li>pH 7.44 </li></ul><ul><li>PCO 2 6.4 kPa </li></ul><ul><li>PO 2 11.1 kPa </li></ul><ul><li>HCO 3 32 mmol/L </li></ul><ul><li>Base excess +4 mmol/l </li></ul><ul><li>Electrolyte: </li></ul><ul><li>Na 133 mmol/L </li></ul><ul><li>K 3.0 mmol/L </li></ul><ul><li>Cl 91 mmol/L </li></ul>Laboratory results:
    10. 11. <ul><li>1) Describe her acid-base status. </li></ul><ul><li> Compensated metabolic alkalosis </li></ul><ul><li>Explain the electrolyte abnormalities. </li></ul><ul><li>- Vomiting causes loss of H + in gastric juice. Normal response of the kidneys is to increase excretion of HCO 3 </li></ul><ul><li>to restore acid-base balance. </li></ul><ul><li>- However, persistent vomiting also leads to fluid, Na, K, and Cl depletion. In this circumstance the overriding goal of the kidneys is salt & water retention. </li></ul><ul><li>Manage this patient. </li></ul><ul><li>IV administration of fluid and electrolyte would allow kidneys to excrete more HCO 3 , thus correcting the alkalosis </li></ul>

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