Case of Mr. B is a 70-year-old man who developed sub sternal chest pains radiating down his left arm while at home

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Question

Mr. B is a 70-year-old man who developed sub sternal chest pains radiating down his left arm while at home. He was taken to the ER via ambulance. His breathing was labored, pulses rapid and weak, and his skin was cold and clammy. An ECG was done which revealed significant “Q” waves in most leads. Troponin level was elevated. Arterial blood was draw with the following results:

Ph 7.22

PCO2 30 mm

Hg pO2 70 mm

Hg O2 sat 88%

HCO3 22 meq/liter

Aside from the obvious diagnosis of MI, what is Mr. B’s acid base status and what caused this disturbance?

Answer

Mr. B’s arterial blood gas (ABG) values indicate a mixed acid-base disorder, primarily characterized by respiratory acidosis with metabolic compensation. The low pH of 7.22 signifies acidemia, indicative of increased hydrogen ion concentration. The PCO2 level of 30 mm Hg, below the normal range of 35-45 mm Hg, suggests respiratory alkalosis. Simultaneously, the HCO3 level of 22 meq/liter indicates a compensatory metabolic response to the acidosis, aiming to normalize the pH.

The cause of the respiratory acidosis can be linked to Mr. B’s labored breathing, potentially resulting from decreased lung function during his MI. Inadequate oxygenation and increased carbon dioxide retention contribute to respiratory acidosis. The elevated Troponin levels and significant “Q” waves in the ECG suggest myocardial damage, causing impaired cardiac function. This, in turn, led to compromised perfusion and oxygenation of tissues, triggering respiratory distress and acidosis.

Furthermore, the reduced pO2 of 70 mm Hg and O2 saturation of 88% indicate impaired oxygen exchange, likely due to decreased cardiac output and compromised blood flow. The combination of respiratory acidosis and metabolic compensation reflects the intricate physiological response to the MI, involving both the respiratory and metabolic systems in an attempt to maintain acid-base balance.

In summary, Mr. B’s acid-base status is characterized by respiratory acidosis with metabolic compensation. The underlying cause is the compromised respiratory function secondary to his myocardial infarction. The respiratory acidosis arises from inadequate ventilation, leading to increased carbon dioxide levels, while the metabolic compensation attempts to counterbalance the acidosis. The overall disturbance reflects the intricate interplay between cardiac and respiratory functions during a critical event like myocardial infarction.

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