ACID NORMAL BASE

1. A cigarette vendor was brought to the emergency department of a

hospital after she fell into the ground and hurt her left leg. She is noted
to be tachycardic and tachypneic. Painkillers were carried out to lessen
her pain. Suddenly, she started complaining that she is still in pain and
now experiencing muscle cramps, tingling, and paraesthesia.
Measurement of arterial blood gas reveals pH 7.6, PaO2 120 mm Hg,
PaCO2 31 mm Hg, and HCO3 25 mmol/L. What does this mean?

HC O 3 pH

PaC O2

ANSWER: RESPIRATORY ALKALOSIS, UNCOMPENSATED

2. Mr. Wales, who underwent post-abdominal surgery, has a nasogastric tube.

The nurse on duty notes that the nasogastric tube (NGT) is draining a large
amount (900 cc in 2 hours) of coffee ground secretions. The client is not
oriented to person, place, or time. The nurse contacts the attending
physician and STAT ABGs are ordered. The results from the ABGs show pH
7.57, PaCO2 37 mmHg and HCO3 30 mEq/L. What is your assessment?

PaC O2 pH

HC O 3
ANSWER: METABOLIC ACIDOSIS, UNCOMPENSATED

3. George Kent is a 54-year-old widower with a history of chronic obstructive

pulmonary disease and was rushed to the emergency department with
increasing shortness of breath, pyrexia, and a productive cough with yellow-
green sputum. He has difficulty in communicating because of his inability to
complete a sentence. One of his sons, Jacob, says he has been unwell for
three days. Upon examination, crackles and wheezes can be heard in the
lower lobes; he has a tachycardia and a bounding pulse. Measurement of
arterial blood gas shows pH 7.3, PaCO2 68 mm Hg, HCO3 28 mmol/L, and
PaO2 60 mm Hg. How would you interpret this?

pH HC O 3

PaC O2

ANSWER: RESPIRATORY ACIDOSIS, PARTIALLY COMPENSATED

4. Carl, an elementary student, was rushed to the hospital due to vomiting and
a decreased level of consciousness. The patient displays slow and deep
(Kussmaul breathing), and he is lethargic and irritable in response to
stimulation. He appears to be dehydrated—his eyes are sunken and mucous
membranes are dry—and he has a two-week history of polydipsia, polyuria,
and weight loss. Measurement of arterial blood gas shows pH 7.0, PaO2
90 mm Hg, PaCO2 23 mm Hg, and HCO3 12 mmol/L; other results are
Na+ 126 mmol/L, K+ 5 mmol/L, and Cl- 95 mmol/L. What is your
assessment?

pH PaC O2
HC O 3

ANSWER: METABOLIC ACIDOSIS, PARTIALLY COMPENSATED

5. Mrs. Johansson, who had undergone surgery in the post- anesthesia care
unit (PACU), is difficult to arouse two hours following surgery. Nurse Florence
in the PACU has been administering Morphine Sulfate intravenously to the
client for complaints of post-surgical pain. The client’s respiratory rate is 7
per minute and demonstrates shallow breathing. The patient does not
respond to any stimuli! The nurse assesses the ABCs (remember Airway,
Breathing, Circulation!) and obtains ABGs STAT! Measurement of arterial
blood gas shows pH 7.10, PaCO2 70 mm Hg and HCO3 24 mEq/L. What
does this mean?

pH HC O3

PaC O2

ANSWER: RESPIRATORY ACIDOSIS, UNCOMPENSATED