Acid-Base Explanation Needed

[js2016]

I am doing a care plan on a patient who has a rather complex set of lab values (at least to me). I need help understanding how to interpret these lab values. Here are his values:

pH: 7.36

pCO2: 48 (High)

pO2: 141 (High)

HCO3: 27.1

Anion: 7

Na: 135

Cl: 104

K: 4.6

Ca: 8.2

Any acid-base pros out there who can break this down into simple terms and explanation?

[AliNajaCat]

Respiratory depression can cause a patient to become acidotic due to build up of CO2. However, the patient would also be hypoxic, he certainly wouldn't have a paO2 over 100. I am honestly stumped at to how he could possibly have a level of 141 without O2 administration. I've only ever seen those types of levels on vented patients.

Can anyone provide any info on that???? I'm super curious.

Completely agree that at sea level, nobody will have a PaO2 > about 100 without supplemental oxygen. I won't bore you with the equation, even though it's actually not that complicated to understand, but the rule of thumb is that normal lungs will give you a PaO2 of 4-5x FIO2, meaning for room air (.21, 21%), PaO2 = about 80-100 torr; for .50 (50%), 200-250torr, and for 1.0 (100%), 400-500torr. The difference between those ideal numbers and the actual ones your patient achieves gives you a rough idea of how lousy his lungs are. So, for example, somebody on 40% O2 who has a PaO2 of 100 isn't doing great, because he should have a PaO2 of around 160-200. Somebody on 80% 02 who has a PaO2 of 100 is really in trouble, because his should be like 320-400.

So. This example was a lady who was a chronic lunger who a new grad on night shift didn't know that the new doc had ordered "3/4 LPM" and so put the old bird on 3 LPM, and when she didn't do so hot on that, cranked her up to 4 LPM. This lady hadn't seen this much oxygen in her blood since the Eisenhower administration, so she pretty much stopped breathing. So that caused her CO2 rose to near-lethal levels before her O2 dropped far enough to make her breathe. Remember that in normal people, elevated CO2 increases resps, but in chronic CO2 retainers that reflex is dead and gone, so it's hypoxia that drives their resp rate.

So what happened is that an old experienced nurse came in at 0700, saw this (and knew the patient from many previous admissions), ripped off the O2 and bagged the heck out of her. And delivered an on-the-spot ABG lesson to the new grad.

And THAT's why I used to teach ABGs to students and new grads.