ABG CASE STUDIES

CLASSROOM AND GROUP DISCUSSION

 CASE STUDY 1 MR. FRANK

MR. FRANK IS A 60 YEAR OLD WITH WHAT IS YOUR INTERPRETATION? WHAT

PNEUMONIA. HE IS ADMITTED WITH DYSPNEA, INTERVENTIONS WOULD BE APPROPRIATE FOR
FEVER, AND CHILLS. HIS BLOOD GAS IS BELOW:
MR. FRANK?
PH 7.28
CO2 56
P02 70
HCO3 25
SAO2 89%
 ANSWERS FOR MR. FRANK

MR. FRANK HAS UNCOMPENSATED RESPIRATORY ACIDOSIS WITH HYPOXEMIA AS A RESULT OF HIS
PNEUMONIA.
THIS IS DUE TO INADEQUATE VENTILATION AND PERFUSION.
THE TREATMENT GOALS FOR MR. FRANK WOULD BE TO IMPROVE BOTH VENTILATION AND
OXYGENATION.
VENTILATION MAY IMPROVE WITH THE USE OF BRONCHODILATORS AND PULMONARY HYGIENE. IF
NOT, MR. FRANKS MAY REQUIRE CPAP, BIPAP, OR INTUBATION AND MECHANICAL VENTILATION.
OXYGEN THERAPY SHOULD CONSIST OF ONLY THE MINIMAL AMOUNT NECESSARY TO INCREASE HIS
OXYGEN SATURATION TO NORMAL (95%)
 CASE STUDY 2 MS. STRAUSS

MS. STRAUSS IS A 24 YEAR OLD COLLEGE STUDENT. SHE WHAT IS YOUR INTERPRETATION?
HAS A HISTORY OF CROHN’S DISEASE AND IS
COMPLAINING OF A FOUR DAY HISTORY OF BLOODY- WHAT INTERVENTIONS WOULD BE
WATERY DIARRHEA. A BLOOD GAS IS OBTAINED TO
APPROPRIATE FOR MS. STRAUSS?
ASSESS HER ACID-BASE BALANCE:
PH 7.28
CO2 43
P02 88
HCO3 20
SAO2 96%
 ANSWERS FOR MS. STRAUSS

MRS. STRAUSS HAS AN UNCOMPENSATED METABOLIC ACIDOSIS. THIS IS DUE TO EXCESSIVE

BICARBONATE LOSS FROM HER DIARRHEA.
IT IS INTERESTING TO NOTE THAT SHE HAS NO COMPENSATION. NORMALLY, THE RESPIRATORY
CENTER COMPENSATES QUICKLY FOR METABOLIC DISORDERS.
HOWEVER, IN MS. STRAUSS CASE SHE WOULD HAVE TO HYPERVENTILATE IN ORDER TO COMPENSATE.
THIS MAY NOT BE POSSIBLE IN HER PRESENT CONDITION, AND SHOULD BE EVALUATED FURTHER.
TREATMENT WOULD CONSIST OF CONTROL OF DIARRHEA AND BOWEL REST. IT SHOULD NOT BE
NECESSARY TO ADMINISTER BICARBONATE IN HER PRESENT CONDITION.
 CASE STUDY 3 MR. KARL

MR. KARL IS A 80 YEAR OLD NURSING HOME RESIDENT WHAT IS YOUR INTERPRETATION?
ADMITTED WITH UROSEPSIS. OVER THE LAST 2 HOURS
HE HAS DEVELOPED SHORTNESS OF BREATH AND IS WHAT INTERVENTIONS WOULD BE
BECOMING CONFUSED. HIS ABGS SHOWS THE
FOLLOWING RESULTS: APPROPRIATE FOR MR. KARL?
PH 7.02
CO2 55
P02 77
HC03 14
SA02 89%
 ANSWERS FOR MR. KARL

MR. KARL HAS METABOLIC AND RESPIRATORY ACIDOSIS WITH HYPOXEMIA. THE METABOLIC ACIDOSIS IS
CAUSED BY HIS SEPSIS. THE RESPIRATORY ACIDOSIS IS SECONDARY TO RESPIRATORY FAILURE.
THE PRESENTATION OF SEPSIS AND ASSOCIATED RESPIRATORY FAILURE IS CONSISTENT WITH ARDS
TREATMENT MUST BE AGGRESSIVE, BECAUSE IS ACIDOSIS IS SEVERE. HIS RESPIRATORY STATUS NEEDS TO BE
STABILIZED, AND WOULD PROBABLY REQUIRE MECHANICAL VENTILATION.
IF HYPOTENSION EXISTS, AGGRESSIVE FLUID AND VASOPRESSOR SUPPORT WOULD BE WARRANTED.
THIS PATIENT IS AT HIGH RISK FOR FURTHER COMPLICATIONS AND SHOULD BE MANAGED IN AN ICU.
BICARBONATE SHOULD NOT BE ADMINISTERED UNTIL THE UNDERLYING SEPSIS AND RESPIRATORY FAILURE IS
TREATED.
 CASE STUDY 4 MRS. LAUDER

MRS. LAUDER IS A THIN, ELDERLY-LOOKING 61 YEAR WHAT IS YOUR INTERPRETATION?

OLD COPD PATIENT. SHE HAS AN ABG DONE AS PART
OF HER ROUTINE CARE IN THE PULMONARY CLINICAL. WHAT INTERVENTIONS WOULD BE
THE RESULTS ARE AS FOLLOWS: APPROPRIATE FOR MRS. LAUDER?
PH 7.37
C02 63
P02 58
HC03 35
SAO2 89%
 ANSWERS FOR MRS. LAUDER

MRS. LAUDER HAS A FULLY COMPENSATED RESPIRATORY ACIDOSIS WITH HYPOXEMIA.

FULL COMPENSATION IS EVIDENCED BY THE NORMAL PH IN SPITE OF HER ACID/BASE DISORDER.
THIS IS HER BASELINE AND DOESN’T REQUIRE TREATMENT.
 CASE STUDY 5 MS. STEELE

MS. STEELE IS A 17 YEAR OLD WITH INTRACTABLE WHAT IS YOUR INTERPRETATION?

VOMITING. SHE HAS SOME ELECTROLYTE
ABNORMALITIES, SO A BLOOD GAS IS OBTAINED WHAT INTERVENTIONS WOULD BE
TO ASSESS HER ACID/BASE BALANCE: APPROPRIATE FOR MS. STEELE?
PH 7.50
C02 36
P02 92
HC03 27
SAO2 97%
 ANSWERS FOR MS. STEELE

MS. STEELE HAS AN UNCOMPENSATED METABOLIC ACIDOSIS. THIS IS DUE TO VOMITING THAT
RESULTS IN EXCESSIVE LOSS OF STOMACH ACID.
TREATMENT CONSISTS OF FLUID, ANTIEMETICS, AND MANAGEMENT OF HER ELECTROLYTE
DISORDERS.
 CASE STUDY 6 MR. LONGO

MR. LONGO IS A 18 YEAR OLD COMATOSE, WHAT IS YOUR INTERPRETATION?

QUADRIPLEGIC PATIENT WHO HAS THE
FOLLOWING ABG DONE AS PART OF A MEDICAL WHAT INTERVENTIONS WOULD BE
WORKUP: APPROPRIATE FOR MR. LONGO?
PH 7.48
C02 22
P02 96
HCO3 16
SA02 98%
 ANSWERS FOR MR. LONGO

AS A RESULT OF HIS NEUROLOGICAL CONDITION, MR. LONGO HAS CHRONIC

HYPERVENTILATION SYNDROME. HIS BLOOD GAS SHOWS A FULLY COMPENSATED
RESPIRATORY ALKALOSIS.
THIS IS A CHRONIC AND STABLE CONDITION FOR HIM AND PROBABLY REQUIRES NO TREATMENT
 CASE STUDY 7 MR. CASPER

MR. CASPER IS A 55 YEA OLD WITH GERD. HE WHAT IS YOUR INTERPRETATION?

TAKES ABOUT 16 TUMS ANTACID TABLETS A DAY.
AN ABG IS OBTAINED TO ASSESS HIS ACID/BASE WHAT INTERVENTIONS WOULD BE
BALANCE: APPROPRIATE FOR MR. CASPER?
PH 7.46
C02 42
P02 86
HC03 29
SA02 97%
 ANSWERS FOR MR. CASPER

MR. CASPER HAS OVERMEDICATED HIMSELF WITH TUMS, EFFECTIVELY ABSORBING TOO MUCH
STOMACH ACID.
HIS ABG SHOWS A PARTIALLY COMPENSATED METABOLIC ALKALOSIS.
TREATMENT CONSISTS OF BETTER CONTROL OF HIS GERD, POSSIBLY WITH H2 BLOCKERS
(PEPCID)OR PROTON-PUMP INHIBITORS(PRILOSEC)
 CASE STUDY 8 MRS. DOBINS

MRS. DOBINS IS FOUND PULSELESS AND NOT WHAT IS YOUR INTERPRETATIONS?

BREATHING THIS MORNING. AFTER A COUPLE OF
MINUTES OF CPR SHE RESPONDS WITH A PULSE AND WHAT INTERVENTIONS WOULD BE
STARTS BREATHING ON HER OWN. A BLOOD GAS IS
OBTAINED: APPROPRIATE FOR MRS. DOBINS?
PH 6.89
C02 70
P02 42
HCO3 13
SA02 50%
 ANSWERS FOR MRS. DOBINS

MRS. DOBINS HAS SEVERE METABOLIC AND RESPIRATORY ACIDOSIS WITH HYPOXEMIA. THE
METABOLIC COMPONENT COMES FOR HER DECREASED PERFUSION, AND THE RESPIRATORY
COMPONENT COMES FROM INADEQUATE VENTILATION
TREATMENT WOULD CONSIST OF INTUBATION, MECHANICAL VENTILATION, BLOOD PRESSURE
AND CIRCULATORY SUPPORT.
 CASE STUDY 9 MR. SIMMONS

AFTER RESUSCITATION MRS. DOBINS, YOU FIND MR. WHAT IS YOUR INTERPRETATION?
SIMMONS TO BE IN RESPIRATORY DISTRESS. HE HAS A
HISTORY OF TYPE 1 DIABETES MELLITES AND IS NOW WHAT INTERVENTIONS WOULD BE
FEBRILE (WOW, WHAT A BAD DAY!). HIS ABGS
SHOWS: APPROPRIATE FOR MR. SIMMONS?
PH 7.00
C02 59
P02 86
HC03 14
SA02 91%
 ANSWERS FOR MR. SIMMONS

WOW! MRS. SIMMONS TOO! HE, LIKE MRS. DOBINS, HAS METABOLIC AND RESPIRATORY
ACIDOSIS WITH HYPOXEMIA. HOWEVER, HIS CAUSE IS DIFFERENT. HIS RESPIRATORY ACIDOSIS IS
PROBABLY THE RESULT OF PNEUMONIA (ALSO CAUSING THE FEVER).
HIS PNEUMONIA HAS ALTERED HIS GLUCOSE METABOLISM, CAUSING HYPERGLYCEMIA AND
DIABETIC KETOACIDOSIS.
TREATMENT SHOULD BE THREE-PRONGED: 1) INCREASE HIS OXYGENATION WITH OXYGEN
THERAPY LIKE CPAP, BIPAP, OR MV, 2) TREAT HIS PNEUMONIA WITH ANTIBIOTICS, ANTIPYRETICS,
AND GOOD PULMONARY HYGIENE., AND 3) ADMINISTER INSULIN AND IV FLUIDS TO DECREASE
HIS BLOOD GLUCOSE AND TREAT HIS DKA.
 CASE STUDY 10 MS. BERTH

MS. BERTH WAS ADMITTED FOR A DRUG OVERDOSE. WHAT IS YOUR INTERPRETATION?
SHE IS BEING MECHANICALLY VENTILATED AND A
BLOOD GAS IS OBTAINED TO ASSESS HER FOR WHAT INTERVENTIONS WOULD BE
WEANING,. THE RESULTS ARE AS FOLLOWS: APPROPRIATE FOR MS. BERTH?
PH 7.54
C02 19
P02 100
HC03 16
SA02 98%
 ANSWER FOR MS. BERTH

MS. BERTH IS BEING OVER-VENTILATED WHICH CAUSED A PARTIALLY-COMPENSATED

RESPIRATORY ALKALOSIS.
TREATMENT WOULD CONSIST OF DECREASING VENTILATORY SUPPORT, OR TRYING OTHER
MODES OF VENTILATION TO DECREASE HER MINUTE VOLUME. SHE WILL BE DIFFICULT TO WEAN
FROM THE VENTILATOR IN THIS CONDITION DUE TO THE METABOLIC COMPENSATION.
THEREFOR ATTEMPTS SHOULD BE MADE TO ALLOW HER C02 TO INCREASE BACK TO NORMAL
BEFORE WEANING CAN PROCEED.
 CREDITS

WESLEY GRANGER PHD RRT

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