doc_clotaire
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A 54-year-old woman with a long history of emphysema presents because of an exacerbation of her cough and dyspnea. On physical examination, her blood pressure is 126/64 mm Hg, pulse is 82/min, and respirations are 24/min. On lung examination, there are loud expiratory wheezes and rhonchi. The cardiac examination is normal. An arterial blood gas is performed. Which of the following results would most likely be expected?
A. pH of 7.20, pCO2 of 60, and pO2 of 46
B. pH of 7.30, pCO2 of 50, and pO2 of 94
C. pH of 7.35, pCO2 of 45, and pO2 of 60
D. pH of 7.46, pCO2 of 25, and pO2 of 76
E. pH of 7.52, pCO2 of 30, and pO2 of 82
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| titly
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D
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| hanialkhadher
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C. pH of 7.35, pCO2 of 45, and pO2 of 60
Very difficult, i did some search
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| Ivonne
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This is respiratory acidosis so A or C, because the PO2 in B is high so B is rule out. Now this patient has a RR of 24/min that is not bad for a patient with chronic emphysema so I will go with C
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| doc_clotaire
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The correct answer is C
. This patient has an acute exacerbation of her chronic obstructive pulmonary disease (COPD). On the basis of the history and physical examination, she would be expected to have a compensated respiratory acidosis because CO2 retention. Furthermore, she would be expected to have evidence of mild hypoxia. With respirations of 24/min, which is high but not extremely high, she would not be expected to show the severe levels of acidosis and CO2 retention illustrated in choice A. The patient is sufficiently symptomatic that the near normal pO2 of 94 seen in choice B would be unlikely. Although asthmatics may present during an acute exacerbation with a respiratory alkalosis (choices D and E), in a patient with underlying COPD, there is usually a baseline respiratory acidosis
FROM WHAT I UNDERSTAND
Some patients with COPD may have a mild respiratory acidosis with mild to moderate hypoxemia without hypercapnia . For these patients to have Hypercapnia , the FEV 1 would have to fall below 1 L / s or 30 % of the predicted value . Remember , COPD is cronic condition where the kidney are partially ( NOT TOTALLY ) trying to compensate that acid base disturbance reving up bicarbonate ( metabolic alkalosis )
That 's why you would see a BODERLINE RESPIRATORY ACIDOSIS ( ALMOST NORMAL ) and besides as the explanation said above : Choice A is for a SEVERE RESPIRATORY ACIDOSIS in extreme case of hypoxemia and you would find the respiratory rate even higher than 24 / min
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| sandra
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i thought a/c copd exacerbation causes resp alkalosis due to hyperventilation as with a/c asthma exacerbation. or am i all muddled up..would someone plz clear this for me
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| multifactorial
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C
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| multifactorial
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the exacerbation of COPD points towarsd the patient desaturating and going into acidosis,so alkalosis is never found.
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| milestogo
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good question and a beautiful explaination......thanks doc pls be kind to post similar qs if possible
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| mildus
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very nice expl
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