A critical care unit nurse presents to the ED with severe dizziness. She appears

Question

A critical care unit nurse presents to the ED with severe dizziness. She appears to be a fit woman. She was not forth coming for any other history. Her ABG and blood panel are below. Her blood work reveals hyponatremia, hypokalemia and a very high bicarbonate (which can only be due to severe metabolic alkalosis or metabolic compensation for severe respiratory acidosis (more common).

Na+ = 123pH = 7.55

K+ = 3.1Paco2= 50

Cl- = 67Pao2 = 80

HCO3-=42HCO3- = 43

Glu = 125

BUN = 25

Confirm her measured bicarbonate level. Then remember that her Paco2 should go up by 0.6 for each mEq/L her bicarbonate value is over 24. Go ahead and do that math. (2 pts – show your work)Is your calculated number above or equal to her measured Paco2 or is it below that number? If above or equal to, no compensation has occurred, whereas if below, compensation has occurred. Has compensation occurred?

Thanks!!

Explanation / Answer

Her HCO3- = 43 mEq/L and Normal HCO3 = 24 mEq/L (there are 2 value of HCO3 so I chose the valve of 43)

So her HCO3 is increased by 19 mEq/L

It is given that for every 1 unit change in HCO3 beyond 24 will result in increase of pCO2 by 0.6

Therefore expected change in pCO2 should be = 19 × 0.6 = 11.4

And Normal pCO2 is 35 mm of Hg so final expected change

= 35 + 11.4 = 46.4 mm of Hg

Her actual pCO2 = 42 mm of Hg

Her expected calculated velue is more than actual level so respiratory compensation has NOT occured.

Comment if you have any problem in understanding this answer.

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