Assignment Task: 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. The Troponin level was elevated. Arterial blood was drawn 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, 1) what is Mr. B's acid base status and what caused this disturbance- please walk through your thought process on what acid-base balance Mr. B is suffering from; 2) what type of compensation he is experiencing and why; 3) as well as the cause of his issue.
Reply to at least one classmate's initial discussion post
Based on Mr. B.'s arterial blood gas results, it appears as if he is currently experiencing metabolic acidosis. Mr. B.'s pH is low, indicating that his body is in a state of acidosis. Mr. B.'s partial pressure of carbon dioxide is also low, which indicates a metabolic process rather than respiratory process (Huether et al., 2020). It is evident that Mr. B. has suffered a myocardial infarction, and metabolic acidosis is frequently seen in individuals who are critically ill (Kraut & Madias, 2010). Mr. B.'s respiratory system is attempting to compensate for his acidotic state by expelling carbon dioxide through his labored breathing or "Kussmaul respirations." Kussmaul respirations are deep and rapid breaths (Huether et al., 2020). This form of hyperventilation is the body's way of lowering increased carbon dioxide levels (Whited & Graham, 2021). The body recognizes carbon dioxide as a potential acid and engages in respiratory compensation to avoid a further increase in acidemia (Huether et al., 2020).
References
Huether, S. E., McCance, K. L., & Brashers, V. L. (2020). Understanding Pathophysiology 7th ed. Elsevier.
Kraut, J., Madias, N. Metabolic acidosis: pathophysiology, diagnosis and management. Nat Rev Nephrol 6, 274-285 (2010).
Whited, L. & Graham D. D. Abnormal Respirations. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.