ABG Case Study Examples 1. Mr. Frank is a 60 year-old with pneumonia. He is admitted with dyspnea, fever, and chills.

His blood gas is below: pH 7.28 CO2 56 PO2 70 HCO3 25 SaO2 89% What is your interpretation? What interventions would be appropriate for Mr. Frank?

Mr. Frank has an uncompensated respiratory acidosis with hypoxemia as a result of his pneumonia. This is due to inadequate ventilation and perfusion. The treatment goals for Mr. Frank would be to improve both ventilation and oxygenation. Ventilation may improve with the use of bronchodilators and pulmonary hygiene. If not, Mr. Frank may require CPAP, BiPAP, or intubation and mechanical ventilation. Oxygen therapy should consist of only the minimal amount necessary to increase his oxygen saturation to normal (95%).
2. Ms. Strauss is a 24 year-old college student. She has a history of Crohn's disease and is complaining a of a four day history of bloody-watery diarrhea. A blood gas is obtained to assess her acid/base balance: pH 7.28 CO2 43 pO2 88 HCO3 20 SaO2 96% What is your interpretation? What interventions would be appropriate for Ms. Strauss?

Ms. Strauss has an uncompensated metabolic acidosis. This is due to excessive bicarbonate loss from her diarrhea. It is interesting to note that she has no compensation. Normally, the respiratory center compensates quickly for metabolic disorders. However, in Ms. Strauss' case she would have to hyperventilate in order to compensate. This may not be possible in her present condition, and should be evaluated further. Treatment would consist of control of the diarrhea and bowel rest. It should not be necessary to administer bicarbonate in her present condition.
3. Mr. Karl is a 80 year-old nursing home resident admitted with urosepsis. Over the last two hours he has developed shortness of breath and is becoming confused. His ABG shows the following results: pH 7.02 CO2 55 pO2 77 HCO3 14 SaO2 89% What is your interpretation? What interventions would be appropriate for Mr. Karl?

Mr. Karl has a metabolic and respiratory acidosis with hypoxemia. The metabolic acidosis is caused by his sepsis. The respiratory acidosis is secondary to respiratory

failure. This presentation of sepsis and associated respiratory failure is consistent with ARDS. Treatment must be aggressive, because his acidosis is severe. His respiratory status needs to be stabilized, and would probably require mechanical ventilation. If hypotension exists, aggressive fluid and vasopressor support would be warranted. This patient is at high risk for further complications and should be managed in an ICU. Bicarbonate should not be administered until the underlying sepsis and respiratory failure is treated.
4. Mrs. Lauder is a thin, elderly-looking 61 year-old COPD patient. She has an ABG done as part of her routine care in the pulmonary clinic. The results are as follows: pH 7.37 CO2 63 pO2 58 HCO3 35 SaO2 89% What is your interpretation? What interventions would be appropriate for Mrs. Lauder?

Mrs. Lauder has a fully-compensated respiratory acidosis with hypoxemia. Full compensation is evidenced by the normal pH in spite of her acid/base disorder. This is her baseline and doesn't require treatment.
5. Ms. Steele is a 17 year-old with intractable vomiting. She has some electrolyte abnormalities, so a blood gas is obtained to assess her acid/base balance. pH 7.50 CO2 36 pO2 92 HCO3 27 SaO2 97% What is your interpretation? What interventions would be appropriate for Ms. Steele?

Ms. Steele has an uncompensated metabolic alkalosis. This is due to vomiting that results in excessive loss of stomach acid. Treatment consists of fluids, anti-emetics, and management of her electrolyte disorders.
6. Mr. Longo is a 18 year-old comatose, quadriplegic patient who has the following ABG done as part of a medical workup: pH 7.48 CO2 22 pO2 96 HCO3 16 SaO2 98% What is your interpretation? What interventions would be appropriate for Mr. Longo?

As a result of his neurologic condition, Mr. Longo has chronic hyperventilation syndrom. His blood gas shows a fully-compensated respiratory alkalosis. This is a chronic and stable condition for him and probably requires no treatment.

7. Mr. Casper is a 55 year-old with GERD. He takes about 15 TUMS antacid tablets a day. An ABG is obtained to assess his acid/base balance: pH 7.46 CO2 42 pO2 86 HCO3 29 SaO2 97% What is your interpretation? What interventions would be appropriate for Mr. Casper?

Mr. Casper has overmedicated himself with TUMS, effectively absorbing too much stomach acid. His ABG shows a partially-compensated metabolic alkalosis. Treatment consists of better control of his GERD, possibly with H2-blockers (Pepcid) or protonpump inhibitors (Prilosec).
8. Mrs. Dobins is found pulseless and not breathing this morning. After a couple minutes of CPR she responds with a pulse and starts breathing on her own. A blood gas is obtained: pH 6.89 CO2 70 pO2 42 HCO3 13 SaO2 50% What is your interpretation? What interventions would be appropriate for Mrs. Dobins?

Mrs. Dobins has a severe metabolic and respiratory acidosis with hypoxemia. The metabolic component comes from her decreased perfusion, and the respiratory component comes from inadequate ventilation. Treatment would consist of intubation, mechanical ventilation, blood pressure and circulatory support.
9. After resuscitating Mrs. Dobins, you find Mr. Simmons to be in respiratory distress. He has a history of Type-I diabetes mellitus and is now febrile. (Wow, what a bad day). His ABG shows: pH 7.00 CO2 59 pO2 86 HCO3 14 SaO2 91% What is your interpretation? What interventions would be appropriate for Mr. Simmons?

Wow, Mr. Simmons too! He, like Mrs. Dobbins, has a metabolic and respiratory acidosis with hypoxemia. However, the cause is different. His respiratory acidosis is probably the result of pneumonia (also causing the fever). His pneumonia has altered his glucose metabolism, causing hyperglycemia and diabetic ketoacidosis. Treatment should be three-pronged: 1) increase his oxygenation with oxygen therapy; CPAP, BiPAP, or mechanical ventilation, 2) treat his pneumonia with antibiotics, antipyretics, and good pulmonary hygiene, and 3) administer insulin and IV fluids to decrease his blood glucose and treat his DKA.

10. Ms. Berth was admitted for a drug overdose. She is being mechanically ventilated and a blood gas is obtained to assess her for weaning. The results are as follows: pH 7.54 CO2 19 pO2 100 HCO3 16 SaO2 98% What is your interpretation? What interventions would be appropriate for Ms. Berth?

Mrs. Berth is being overventilated which caused a partially-compensated respiratory alkalosis. Treatment would consist of decreasing ventilatory support, or trying other modes of ventilation to decrease her minute volume. She will be difficult to wean from the ventilator in this condition due to the metabolic compensation. Therefore attempts should be made to allow her CO2 to increase back to normal before weaning can proceed.