A 31-year-old man suffering from food poisoning is having severe vomiting for the last 2 days
His blood gas and serum electrolyte analyses revealed the following: pH of 7.60, PaCO2 of 49 mm Hg, an HCO3- of 47 mEq/L, a base excess (BE) of +20 mEq/L, a serum K+ of 2.5 mEq/L, and a serum of Cl– of 92 mEq/L. How would the respiratory therapist assess his acid-base condi-tion?
1. Severe hyperventilation
2. Metabolic alkalosis
3. Adequate compensatory response
4. Minimal hypoventilation
a. 1, 2, and 3 only
b. 2 and 4 only
c. 3 only
d. 2, 3, and 4 only
ANS: B
The patient's pH is well above the normal range of 7.35 to 7.45, so the pH is indicating alkalemia. Respiratory involvement shows the PaCO2 is slightly above normal range of 35 to 45 mm Hg, indicating mild hypoventilation. But, the pH does not represent respiratory acidosis, and then the elevated PaCO2 may be a compensatory response to a primary metabolic problem. The HCO3– is extremely higher than the normal range of 22 to 26 mEq/L. Given the pH is indicating alkalemia, this elevated HCO3− represents metabolic alkalosis. Another indication of metabolic alkalosis is confirmed by the large BE value. Plus, the low serum K+ and Cl– values indicate hypokalemic and hypochloremic metabolic alkalosis. Even though, PaCO2 is slightly elevated, compensation for metabolic alkalosis is minimal. This lack of compensation is consistent with the presence of hypokalemic metabolic alkalosis.
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