A middle age gentleman arrived at the ER with persistent diarrhea for the previous 3 days....

A middle age gentleman arrived at the ER with persistent diarrhea for the previous 3 days. Upon gathering the patient's history, recent foreign travel was noted. The attending physician noted increased respiration and decided to order an ABG. Results are reported as:

ABG Analyte (reference range at 37^oC)	Patient's result
pH (7.35-7.45)	7.21
pCO₂ (35-45 mmHg)	19 mmHg
pO₂ (85-105 mmHg)	96 mmHg
HCO₃ (22-29 mmHG)	7 mmHg
SO₂ (>95%)	96%

1. What is this patient's acid-base status?

2. Why is the bicarbonate result so low?

3. Why does the patient have rapid respiration?

Expert Solution

Answer to Question No.1

Acid-base status – The balance between the acid and base (alkaline) present in the body to maintain a healthy and normal physiological processes is called acid-base balance. It is determined by the measuring the pH, carbon dioxide (acid) and bicarbonate (alkaline) levels in the blood.

In general, a pH level less than 7.0 is considered to be acidic, and pH level greater than 7.0 is considered alkaline (basic).

Abnormal values of these parameters can be signs of certain medical conditions.

In the case mentioned the following are the results:

pH – 7.21

pCO₂ – 73mmHg

HCO₃ – 7 mmHg

As per the results, it can be seen that the pH is lower than 7.4 and the values of pCO₂ and HCO₃ are also low compared to the normal range which indicates the patient has metabolic acidosis – a condition where there is too much acid in the body fluids due to increased acid production and decreased acid excretion. It can be caused due to diarrhea, liver failure, diabetic ketoacidosis, shock or kidney failure.

Answer to Question No.2

Bicarbonate is a chemical compound in the blood that prevents the pH of the blood from becoming too acidic or basic. Bicarbonate is a byproduct of the body’s metabolism which is excreted and reabsorbed by the kidneys, thus regulating the body’s pH or acid balance.

In this case, the patient complained of persistent diarrhea for the past 3 days which indicates the loss of bicarbonate from the body thereby causing metabolic acidosis.

Answer to Question No.3

Partial pressure of Carbon Dioxide is a measure of the dissolved pressure of CO₂ in the blood. It helps in determining the carbon dioxide flow out of the body.

Metabolic acidosis causes hyperventilation, which is rapid initially and becomes relatively shallow as the acidosis becomes severe. Rapid breathing is due to the body’s attempt to expel carbon dioxide in order to reduce or correct the acidosis.

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