A case about respiratory acidosis. this case discussed the metabolism of alcohol, the complication of alcohol and the mechanism of respiratory acidosis

1. CASE 2.1:
TOO MUCH TO DRINK!
Presenter: Arwa Hussain Al-Onayzan.
ID: 215007943.
Serial number: 4.

2. Our case
• A 22-year-old man blacks out and falls, banging his chest on the
corner of a table.
• He is brought to the A&E for examination immediately.
• On arrival, he smells of alcohol and only reacts to strong pain stimuli.
• He is wheezing and his breathing is shallow and slow.
• The left side of his thorax only moves minimally.
• Arterial blood gases are follows: PaO2 = 60 mmHg, PaCO2= 50
mmHg and pH = 7.3.
• Examination shows several ribs on the left side of his body are
fractured.

3. Learning objectives
 The metabolism of Alcohol.
 What is the effect of alcohol generally on the body and
specifically on the nervous and respiratory system (Related to
case).
Explain the abnormal PaO2, PaCO2, PH and their effect.
 Does the patient has tension pneumothorax?
 How can we diagnose the rib fracture? And the damage of
that?
 Respiratory Acidosis definition.
 Causes of Respiratory Acidosis.
 Complication and prevention.
 How can we improve this condition.

4. The metabolism of Alcohol
• Alcohol is mainly metabolized in the liver.
There are 2 enzymes help break apart the alcohol molecule:
• Alcohol dehydrogenase (ADH).
• Aldehyde dehydrogenase (ALDH).

5. Effect of Alcohol in the body system generally

6. Why the patient black out and falls?

7. Effect of Alcohol on the Brain
• Alcohol affects brain chemistry by altering levels of
neurotransmitters.
• Neurotransmitters are chemical messengers that
transmit the signals throughout the body
• The most important NTs with respect to alcohol are:
• 1- Glutamate
• is the major excitatory NT.
• 2- Gamma aminobutyric acid (GABA),
• is an inhibitory neurotransmitter.

8. Effect of Alcohol on the Brain
• Neurotransmitters are either excitatory, or inhibitory.
• Alcohol increases the effects of the inhibitory
neurotransmitter GABA in the brain.
• At the same time, alcohol inhibits the excitatory
neurotransmitter Glutamate.

9. Why the patient is black out?
Alcohol interferes
with the receptors
in the
hippocampus that
transmit glutamate
During this
interference,
alcohol prevents
some receptors
from working, while
activating others.
This process
causes the
neurons to create
steroids
Steroid prevent
neurons from
communicating
with each other
properly
Thus disrupting
long-term
potentiation (LTP),
a process believed
necessary for
learning and
memory

10. Why the patient is falling down?
Alcohol affect
a part of brain
which is called
cerebellum
This
cerebellum
responsible for
coordinates
muscle
movement.
Too much of
alcohol
increases the
effects of the
inhibitory
transmitter
GABA in the
brain
Muscle
movements
become less
coordinated,
less balance
and lead to fall
dawn.

11. Why the patient react only with
strong pain stimuli?
• Too much of Alcohol can cause alcoholic neuropathy:
• Is the name given to peripheral neuropathy that affects
some alcoholics.
• peripheral neuropathy:
• Is a term which describes damage to one or more of the
peripheral nerves.
• The damage means that the messages that travel
between the central and peripheral nervous system are
disrupted.

12. Why the patient breathing is
shallow and slow?
• Medulla: This area of the brain handles such automatic
functions as breathing.
• By acting on the medulla, alcohol slow and shallow
breathing.
Acts as a
depressant
for the
(CNS)
Depress the
medulla
Individual's
heart rate
and blood
pressure
can drop
Respirations
will
significantly
decrease

13. Does the patient has tension
pneumothorax?
• A complete or incomplete fracture of any of the 12 ribs on
either side.
• Could cause:
1. Pneumothorax.
2. Injure the liver if the right 11th and 12th ribs are
fractured and have jagged edges
3. Rupture the spleen if the left 11th and 12th ribs are
fractured and have jagged edges.
• However, we need to do more investigation to diagnose if
the patient has tension pneumothorax.

14. Diagnosis of fractured rib
• Physical examination:
• Inspection ( Rate and pattern of breathing).
• Palpation (Doctor will press gently on the ribs).
• Percussion ( Determine resonance within the lung tissue).
• Auscultation (The quality and intensity of breath sound).
• imaging tests:
X-ray CT scan. MRI. Bone scan.
1- Using low levels of
radiation.
2- Often have problems
revealing fresh rib fractures,
especially if the bone is
merely cracked.
1- Can uncover rib
fractures that X-rays
might miss.
2- Injuries to soft tissues
and BV are also easier
to see on CT scans.
Help in the
detection of
more subtle
rib fractures.
This
technique is
good for
viewing
stress
fractures.

15. Abnormal PaO2, PaCO2, PH and their effect
Values Normal measure In the case
(Abnormal)
Pa O2 100 mmHg 60 mmHg Decreased
Pa CO2 40 mmHg 50 mmHg Increased
pH 7.35-7.45 7.3 Decreased
• As a result of shallow and slow breathing, tidal volume will
decrease and that caused changes the ventilation and
partial pressure of gases.

16. CO2
Water
Carbonic
acid
Bicarbonate
and
hydrogen
ion
Combine
Form
Dissolve
Increase the amount of carbon
dioxide will increase the
formation of hydrogen ions
Decrease pH
Acidosis
Abnormal PaO2, PaCO2, PH and their effect

17. According to the case information our
patient most likely to have:
Respiratory Acidosis.

18. What is Respiratory Acidosis?
• Also called respiratory failure or ventilatory failure.
• Is a condition that occurs when the lungs can’t remove
enough of the carbon dioxide (CO2) produced by the
body.
• Excess CO2 causes the pH of blood and other bodily
fluids to decrease, making them too acidic.

19. Causes of Respiratory Acidosis
• Diseases of the airways (such as asthma and chronic
obstructive lung disease).
• Diseases of the chest (such as scoliosis).
• Diseases affecting the nerves and muscles.
• Drugs that suppress breathing.
• Alcohol.
• Severe obesity.

20. Complications of Respiratory Acidosis
• Due to low O2 levels and increased amounts of carbonic
acid.
• Such as, muscle twitching and muscle tremors.
Muscle
Dysfunction
• Because of increased levels of CO2 in the CNS.
• This can alter a patient's mental state and result in a
headache, anxiety and confusion.
Narcosis
• Due to low oxygen concentrations in the blood.
• organs which require extensive blood flow, such as the kidneys
and the heart.
Organ
Failure
• impaired lung function, either due to problems with the lungs
themselves or due to a decreased breathing rate.
Respiratory
Failure
• Due to decreased O2 and increased CO2 content of the blood.
• is marked by clammy skin, a rapid and weak heartbeat,
shallow breathing, and blue fingernails and lips.
Shock

21. Treatment Options
• Mechanical Ventilation:
• Mechanical ventilation is a mechanism by which it is
possible to aid or substitute
spontaneous breathing mechanically.
• Supplemental Oxygen Therapy:
• In severe cases, it becomes essential to administer
oxygen to the patient.
• Supplemental oxygen therapy and CPAP are usually
prescribed together as a treatment for hypoxemia.

22. Treatment Options
• Transfusion of Packed RBCs:
• Packed red blood cells can be transfused as a treatment
option for patients suffering from hypoxemia.
• This is known to increase the oxygen-carrying capacity of
the blood.
• Intravenous Fluids:
• Mild cases of respiratory acidosis can
be treated by administration of intravenous fluids.
• For severe respiratory acidosis cases,
sodium bicarbonate can be given as an
intravenous fluid for direct effect.

23. Prevention of Respiratory Acidosis
Do not smoke. Do not drink Alcohol.
Losing weight.
Be careful about taking
sedating medicines.

24. Summary
We
talked
about
The effect of
alcohol in the
body system
(Related to
the case)
Abnormal
PaO2,
PaCO2, PH
and their
effect.
How can we
diagnose the
rib fracture?
Alcohol
metabolism.
Respiratory
Acidosis
definition,
causes and
complication.
Treatment
option.

25. Any Question?

27. Reference
• HAMS website (How Alcohol Is Metabolized in the
Human Body by David S. Goodsell).
• Dr. Purna’s lecture (Regulation of reparation).
• Medline plus website (Prevention of Respiratory Acidosis).
• Medscape website (Complications of Respiratory Acidosis).
• Mayoclinic wesite (Broken-ribs diagnosis).
• Healthline website (Respiratory acidosis Treatment and
Respiratory acidosis definition).
• Patient.info website (peripheral-neuropathy)
• GUYTON AND HALL Textbook of Medical
Physiology.