Sunday, November 4, 2007

Physiology That Matters (Almost Medicine)

A 26-year-old man is admitted through the emergency department to the hospital for a heroin overdose. His heart rate is 45 beats/min, and his blood pressure is 75/40 mm Hg. Which of the following best depicts the results from an arterial blood sample ?

pH PaCO2 (mm Hg) HCO3- (mEq/L)
A. 7.22 66 26
B. 7.34 29 15
C. 7.40 40 24
D. 7.47 20 14
E. 7.49 48 35

Correct answer and explanation will be posted next week.

2 comments:

Anonymous said...

I think that if blood flow is sluggish it would mean that CO2 would accumulate and hence I presume that answer E should be plausible. But i'm really not very confident on this.

Themis said...

The correct answer is A.

This man has a respiratory acidosis. Overdose with drugs that suppress ventilation (e.g., heroin, morphine, barbiturates, methaqualone, and "sleeping pills") often causes hypercapnia. In patients with an intact renal response, the respiratory acidosis causes a compensatory rise in plasma HCO3-, which lessens the fall in pH. However, the renal response requires several days to develop fully. The plasma HCO3- of 26 mEq/L (normal: 22-28 mEq/L) for this man is typical of acute respiratory acidosis with little or no renal compensation.

Choice B reflects metabolic acidosis.

Choice C is normal.

Choice D reflects respiratory alkalosis.

Choice E reflects metabolic alkalosis.