Brian, an 80-year-old man with a history of chronic obstructive pulmonary disease (COPD) and respiratory infections, was admitted through the ER with a chronic cough and extreme dyspnea. He complained that he was unable to climb the stairs or anything that required any exertion (even washing his hair). He had been a heavy smoker but had been attempting to stop smoking by cutting back on the number of cigarettes per day. The nurse noted his temperature was 101.2°F.

Arterial Blood Gas Results

Test

Brian

Reference Range

pH

7.23

7.35-7.45

PCO2

75.0

35-45 mm Hg

PO2

28.2

83- 108 mm Hg

HCO3

32.7

22-28 mEq/L

SaO2

49.6

95-98%

COHb

8.6

Nonsmoker: 0.5 -1.5%

Smokers:

packs/day:4-5 %

> 2Packs/day:8-9%

1. What are the abnormal blood gas results?

2. What is Brian’s acid base status (abnormal, acidosis, or alkalosis)?

3. Is the condition that is responsible for the blood gases respiratory, metabolic/nonrespiratory, or mixed? Explain.

4. Is the condition acute or chronic? In other words, is it uncompensated, partially compensated, or fully compensated? Why?

5. What is the primary compensatory mechanism in this acid-base disturbance?
a) What organ(s) is/are the primary compensatory mechanism in this acid-base disorder?
b) List 3 processes it uses to compensate for the acid-base imbalance
c) What other system is responsible for compensatory mechanisms in acid-base disorders? How does it compensate?
d) Why is it often inefficient in this acid-base disorder?

6. Would the oxyhemoglobin dissociation curve be shifted? If yes, what direction (right or left)?

7. What conditions are associated with this acid-base disorder?

8. Which condition is most likely explanation in this case?