You are working in the clinical laboratory and get an arterial blood gas: pH 7.27, PCO2 70 mmHg, serum HCO3 31 meq/L.
Challenge: Your mentor asks you to interpret. Is the patient compensating for the acid-base disturbance?
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2 comments:
Yes, and it signals chronic compensation rather than acute.
yep
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Open Ended Question
This is a respiratory acidosis. If it is acute hypercapnia, then the 30mmHg rise in PCO2 should increase serum HCO3 by 3 meq/L; if it is chronic hypercapnia, then the 30mmHg rise in PCO2 should increase serum HCO3 by 11 meq/L. The observed value of 31 meq/L could represent several scenarios: (1) chronic respiratory acidosis with a superimposed metabolic acidosis (ie. COPD + sepsis), (2) acute respiratory acidosis with a superimposed metabolic alkalosis (overdose leading to vomiting and respiratory depression, (3) acute respiratory acidosis superimposed on mild chronic respiratory acidosis (COPD + pneumonia), or (4) acute respiratory acidosis evolving into chronic respiratory acidosis (between 1-3 days).
Source: UpToDate.
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